Thiele de Cássia Libardoni

Sintomas e limitações funcionais de pacientes com síndrome da dor patelofemoral

BACKGROUND AND OBJECTIVES: Patellofemoral pain syndrome (PFPS) is one of the commonest disorders affecting knee joint. This study aimed at evaluating symptoms and functional limitations of PFPS patients. METHOD: Participated in this study 26 PFPS patients (PFPSG) and 31 clinically healthy patients (CG), paired by age, height and body mass. Evaluation cards and Kujala questionnaire were applied. Then patients went through two functional tests: crouching, climbing and descending a step for 30 seconds, in addition to being oriented to walk 8 m in a leveled surface, to climb and descend a stair and a ramp, and such activities were randomly performed. Pain intensity was evaluated through the visual analog scale (VAS) before and after each activity. Wilcoxon and U Mann-Whitney tests were used for statistical analysis, considering significant p = 0.05. RESULTS: The PFPS group had lower scores (75.8 ± 11.8) in Kujala questionnaire, as compared to the C group (100 ± 0.0) (p = 0.001). From 26 PFPS patients, 23 reported pain when crouching, 18 when climbing or descending stairs, 25 when kneeing, 14 when running, 16 when sitting for a long period and 9 when practicing sports. Pain intensity by VAS has confirmed such statements with pain exacerbation after crouching (p = 0.001), climbing and descending a step (p = 0.001), walking on a leveled surface (p = 0.01), climbing and descending a stair ( p = 0.001) and ramp (p = 0.01) in patients with PFPS. CONCLUSION: PFPS may lead to pain and functional limitations which impair daily life activities.

VASTUS LATERALIS OBLIQUE ACTIVITY DURING GAIT OF SUBJECTS WITH PATELLOFEMORAL PAIN

Introduction: So far, little is known about the behavior of electromyographic activity of vastus lateralis oblique muscle during treadmill gait in subjects with and without patellofemoral pain syndrome. Objective: The purpose of this study was to investigate the electromyographic activity of the patellar stabilizers muscles and the angle of the knee joint flexion in subjects with and without patellofemoral pain syndrome. Method: Fifteen subjects without (21 ± 3 years) and 12 with patellofemoral pain syndrome (20 ± 2 years) were evaluated. The electromyographic activity and flexion angle of the knee joint were obtained during gait on the treadmill with a 5 degree inclination. Results: The knee flexion angle was significantly lower in the subjects with patellofemoral pain syndrome when compared with the healthy controls. The electromyographic activity of vastus lateralis longus was significantly greater during gait on the treadmill with inclination in subjects with patellofemoral pain syndrome. The results also showed that the electromyographic activity of vastus lateralis oblique and vastus medialis oblique were similar in both groups, regardless of the condition (with/without inclination). Conclusion: We have shown that knee kinematics during gait differs among patients with and without patellofemoral pain syndrome and healthy controls and that a different motor strategy persists even when the pain is no longer present. In addition, the findings suggested that the vastus lateralis oblique has a minor role in patellar stability during gait.

Avaliação isocinética, dor e funcionalidade de sujeitos com síndrome da dor patelofemoral

| This study aimed at determining the influence of patellofemoral pain syndrome (PFPS) on torque peak and the work of knee flexor and extensor muscles, in addition to evaluating the pain and functionality of individuals that have this dysfunction. Fifty-two female subjects, 23 with diagnosis of PFPS, and 29 control subjects, clinically healthy and similar in age, height, and body mass participated in this study. The isokinetic evaluation was performed on concentric mode for knee flexors and extensors at speeds of 60° and 180°/s. The Visual Numerical Scale and the Kujala questionnaire were also applied before and after each speed of isokinetic testing. The data were analyzed through descriptive and inferential statistics (U Mann–Whitney, Wilcoxon, and independent t-tests) with a significance level of α=0.05. The patellofemoral pain syndrome group had lower scores (p=0.01) on the Kujala questionnaire (75.7±12.3 points) in relation to the control group (100±0.0 points), and lower peak torque of knee flexors (0.82±0.24 Nm/kg; 0.51±0.22 Nm/kg) and extensors (1.85±0.48 Nm/kg; 1.13±0.44 Nm/kg) at 60° and 180°/s as well as lower total work of knee extensors at 180°/s (6.46±2.54 Joules/kg) and 60°/s (9.42±3.27 Joules/kg). In addition, there was exacerbation of pain in the patellofemoral pain syndrome group after the isokinetic evaluation at 180°/s (0.9 cm) and 60°/s (2.3 cm). The results evidenced that individuals with PFPS have lower functional capacity, lower torque peak, and decreased function of knee flexors and extensors, which suggests that strengthening these muscles must be considered in the rehabilitation of these subjects.Este estudo visou determinar a influencia da Sindrome da Dor Patelofemoral (SDPF) sobre o pico de torque e trabalho da musculatura flexora e extensora do joelho, alem de avaliar a dor e funcionalidade de sujeitos com a disfuncao. Participaram 52 sujeitos do genero feminino, 23 com SDPF e 29 clinicamente saudaveis similares em idade, estatura e massa corporal. A avaliacao isocinetica foi realizada no modo concentrico para os flexores e extensores do joelho nas velocidades de 60 e 180°/s. Tambem foi aplicada a Escala Visual Numerica antes e apos cada velocidade do teste isocinetico e o questionario de Kujala. Os dados foram analisados pela estatistica descritiva e inferencial (testes U de Mann-Whitney, Wilcoxon e t independente) com nivel de significância de α=0,05. O Grupo com Sindrome da Dor Patelofemoral (GSDPF) apresentou menor pontuacao (p=0,01) no questionario de Kujala (75,7±12,3 pontos) em relacao ao Grupo Controle (GC) (100±0,0 pontos), alem de menor pico de torque, tanto em 60 como 180°/s, dos flexores (0,82±0,24 Nm/kg; 0,51±0,22 Nm/kg) e extensores (1,85±0,48 Nm/kg; 1,13±0,44 Nm/kg) do joelho, bem como menor trabalho total dos extensores do joelho a 180°/s (6,46±2,54 J/kg) e 60°/s (9,42±3,27 J/kg). Alem disso, foi observado aumento da dor do GSDPF apos a avaliacao isocinetica a 180°/s (0,9 cm) e 60°/s (2,3 cm). Os resultados evidenciaram que sujeitos com SDPF possuem menor capacidade funcional e menor pico de torque e trabalho dos flexores e extensores do joelho, sugerindo que o fortalecimento desta musculatura deve ser considerado na reabilitacao destes sujeitos.

Isokinetic evaluation, pain and functionality of subjects with patellofemoral pain syndrome

| This study aimed at determining the influence of patellofemoral pain syndrome (PFPS) on torque peak and the work of knee flexor and extensor muscles, in addition to evaluating the pain and functionality of individuals that have this dysfunction. Fifty-two female subjects, 23 with diagnosis of PFPS, and 29 control subjects, clinically healthy and similar in age, height, and body mass participated in this study. The isokinetic evaluation was performed on concentric mode for knee flexors and extensors at speeds of 60° and 180°/s. The Visual Numerical Scale and the Kujala questionnaire were also applied before and after each speed of isokinetic testing. The data were analyzed through descriptive and inferential statistics (U Mann–Whitney, Wilcoxon, and independent t-tests) with a significance level of α=0.05. The patellofemoral pain syndrome group had lower scores (p=0.01) on the Kujala questionnaire (75.7±12.3 points) in relation to the control group (100±0.0 points), and lower peak torque of knee flexors (0.82±0.24 Nm/kg; 0.51±0.22 Nm/kg) and extensors (1.85±0.48 Nm/kg; 1.13±0.44 Nm/kg) at 60° and 180°/s as well as lower total work of knee extensors at 180°/s (6.46±2.54 Joules/kg) and 60°/s (9.42±3.27 Joules/kg). In addition, there was exacerbation of pain in the patellofemoral pain syndrome group after the isokinetic evaluation at 180°/s (0.9 cm) and 60°/s (2.3 cm). The results evidenced that individuals with PFPS have lower functional capacity, lower torque peak, and decreased function of knee flexors and extensors, which suggests that strengthening these muscles must be considered in the rehabilitation of these subjects.Este estudo visou determinar a influencia da Sindrome da Dor Patelofemoral (SDPF) sobre o pico de torque e trabalho da musculatura flexora e extensora do joelho, alem de avaliar a dor e funcionalidade de sujeitos com a disfuncao. Participaram 52 sujeitos do genero feminino, 23 com SDPF e 29 clinicamente saudaveis similares em idade, estatura e massa corporal. A avaliacao isocinetica foi realizada no modo concentrico para os flexores e extensores do joelho nas velocidades de 60 e 180°/s. Tambem foi aplicada a Escala Visual Numerica antes e apos cada velocidade do teste isocinetico e o questionario de Kujala. Os dados foram analisados pela estatistica descritiva e inferencial (testes U de Mann-Whitney, Wilcoxon e t independente) com nivel de significância de α=0,05. O Grupo com Sindrome da Dor Patelofemoral (GSDPF) apresentou menor pontuacao (p=0,01) no questionario de Kujala (75,7±12,3 pontos) em relacao ao Grupo Controle (GC) (100±0,0 pontos), alem de menor pico de torque, tanto em 60 como 180°/s, dos flexores (0,82±0,24 Nm/kg; 0,51±0,22 Nm/kg) e extensores (1,85±0,48 Nm/kg; 1,13±0,44 Nm/kg) do joelho, bem como menor trabalho total dos extensores do joelho a 180°/s (6,46±2,54 J/kg) e 60°/s (9,42±3,27 J/kg). Alem disso, foi observado aumento da dor do GSDPF apos a avaliacao isocinetica a 180°/s (0,9 cm) e 60°/s (2,3 cm). Os resultados evidenciaram que sujeitos com SDPF possuem menor capacidade funcional e menor pico de torque e trabalho dos flexores e extensores do joelho, sugerindo que o fortalecimento desta musculatura deve ser considerado na reabilitacao destes sujeitos.

Evaluación isocinética, dolor y funcionalidad de sujetos con síndrome de dolor patelofemoral

| This study aimed at determining the influence of patellofemoral pain syndrome (PFPS) on torque peak and the work of knee flexor and extensor muscles, in addition to evaluating the pain and functionality of individuals that have this dysfunction. Fifty-two female subjects, 23 with diagnosis of PFPS, and 29 control subjects, clinically healthy and similar in age, height, and body mass participated in this study. The isokinetic evaluation was performed on concentric mode for knee flexors and extensors at speeds of 60° and 180°/s. The Visual Numerical Scale and the Kujala questionnaire were also applied before and after each speed of isokinetic testing. The data were analyzed through descriptive and inferential statistics (U Mann–Whitney, Wilcoxon, and independent t-tests) with a significance level of α=0.05. The patellofemoral pain syndrome group had lower scores (p=0.01) on the Kujala questionnaire (75.7±12.3 points) in relation to the control group (100±0.0 points), and lower peak torque of knee flexors (0.82±0.24 Nm/kg; 0.51±0.22 Nm/kg) and extensors (1.85±0.48 Nm/kg; 1.13±0.44 Nm/kg) at 60° and 180°/s as well as lower total work of knee extensors at 180°/s (6.46±2.54 Joules/kg) and 60°/s (9.42±3.27 Joules/kg). In addition, there was exacerbation of pain in the patellofemoral pain syndrome group after the isokinetic evaluation at 180°/s (0.9 cm) and 60°/s (2.3 cm). The results evidenced that individuals with PFPS have lower functional capacity, lower torque peak, and decreased function of knee flexors and extensors, which suggests that strengthening these muscles must be considered in the rehabilitation of these subjects.Este estudo visou determinar a influencia da Sindrome da Dor Patelofemoral (SDPF) sobre o pico de torque e trabalho da musculatura flexora e extensora do joelho, alem de avaliar a dor e funcionalidade de sujeitos com a disfuncao. Participaram 52 sujeitos do genero feminino, 23 com SDPF e 29 clinicamente saudaveis similares em idade, estatura e massa corporal. A avaliacao isocinetica foi realizada no modo concentrico para os flexores e extensores do joelho nas velocidades de 60 e 180°/s. Tambem foi aplicada a Escala Visual Numerica antes e apos cada velocidade do teste isocinetico e o questionario de Kujala. Os dados foram analisados pela estatistica descritiva e inferencial (testes U de Mann-Whitney, Wilcoxon e t independente) com nivel de significância de α=0,05. O Grupo com Sindrome da Dor Patelofemoral (GSDPF) apresentou menor pontuacao (p=0,01) no questionario de Kujala (75,7±12,3 pontos) em relacao ao Grupo Controle (GC) (100±0,0 pontos), alem de menor pico de torque, tanto em 60 como 180°/s, dos flexores (0,82±0,24 Nm/kg; 0,51±0,22 Nm/kg) e extensores (1,85±0,48 Nm/kg; 1,13±0,44 Nm/kg) do joelho, bem como menor trabalho total dos extensores do joelho a 180°/s (6,46±2,54 J/kg) e 60°/s (9,42±3,27 J/kg). Alem disso, foi observado aumento da dor do GSDPF apos a avaliacao isocinetica a 180°/s (0,9 cm) e 60°/s (2,3 cm). Os resultados evidenciaram que sujeitos com SDPF possuem menor capacidade funcional e menor pico de torque e trabalho dos flexores e extensores do joelho, sugerindo que o fortalecimento desta musculatura deve ser considerado na reabilitacao destes sujeitos.