Nº de abstracts = 45

 

Modificado em 23 Fevereiro

Internet-enhanced management of fibromyalgia: a randomized controlled trial.

Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DJ.: Pain, 2010, 151(3):694-702. Chronic Pain and Fatigue Research Center, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby M, Ann Arbor, MI 48106, USA.

Both pharmacological and non-pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non-pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet-based exercise and behavioral self-management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web-Enhanced Behavioral Self-Management program (WEB-SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB-SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no-contact, Internet-based, self-management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non-pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.

Contributing factors to patient non-attendance at and non-completion of Phase III cardiac rehabilitation.

Kerins M, McKee G, Bennett K, European journal of Cardiovascular Nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2011, 10(1):31-6. Cardiac Rehabilitation Unit, CReST Directorate, St James's Hospital, James Street, Dublin 8, Ireland. BACKGROUND: Cardiac rehabilitation (CR) is generally underutilized. AIM: The aim of this study was to describe the rate of non-attendance after enrolment and non-completion after commencement to Phase III CR and to explore associated factors. METHOD: A review of medical records was carried out to determine the profile of all patients who enrolled on a CR programme. Patients who enrolled but did not attend or did not complete the programme were surveyed to ascertain the primary underlying reasons for this. A convenience sub-sample of these was then selected for semi-structured interviews (n=7) to explore the reasons for non-attendance/non-completion further. RESULTS: Of the patients that enrolled, 11% (n=29) did not attend and 19% (n=51) did not complete the programme. The non-attendees and non-completers were significantly more likely to be unskilled manual workers (p=0.018) or smokers (p=0.001). Illness and not interested were the most common primary reasons for non-attendance and non-completion respectively. Further qualitative exploration of the contributing factors revealed exercise, depression and organizational factors contributed to these reasons. CONCLUSIONS: The study highlights that individual patient profiles and needs, if unmet contribute to poor attendance. This suggests that if these needs were identified and addressed more comprehensively throughout CR, attendance at Phase III programmes would improve.

Acute effect of different stretching methods on Illinois agility test in soccer players.

Amiri-Khorasani M, Sahebozamani M, Tabrizi KG, Yusof AB.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 2010, 24(10):2698.- Sports Centre, University of Malaya, Malaysia.

The purpose of this study was to examine the effects of static, dynamic, and the combination of static and dynamic stretching within a pre-exercise warm-up on the Illinois agility test (IAT) in soccer players. Nineteen professional soccer players (age = 22.5 ± 2.5 years, height = 1.79 ± 0.003 m, body mass = 74.8 ± 10.9 kg) were tested for agility performance using the IAT after different warm-up protocols consisting of static, dynamic, combined stretching, and no stretching. The players were subgrouped into less and more experienced players (5.12 ± 0.83 and 8.18 ± 1.16 years, respectively). There were significant decreases in agility time after no stretching, among no stretching vs. static stretching; after dynamic stretching, among static vs. dynamic stretching; and after dynamic stretching, among dynamic vs. combined stretching during warm-ups for the agility: mean ± SD data were 14.18 ± 0.66 seconds (no stretch), 14.90 ± 0.38 seconds (static), 13.95 ± 0.32 seconds (dynamic), and 14.50 ± 0.35 seconds (combined). There was significant difference between less and more experienced players after no stretching and dynamic stretching. There was significant decrease in agility time following dynamic stretching vs. static stretching in both less and more experienced players. Static stretching does not appear to be detrimental to agility performance when combined with dynamic warm-up for professional soccer players. However, dynamic stretching during the warm-up was most effective as preparation for agility performance. The data from this study suggest that more experienced players demonstrate better agility skills due to years of training and playing soccer.

Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review

M M Favejee, B M A Huisstede, B W Koes.: Br J Sports Med, 2011; 45:49-56.

Background A variety of therapeutic interventions is available for restoring motion and diminishing pain in patients with frozen shoulder. An overview article concerning the evidence for the effectiveness of these interventions is lacking. Objective To provide an evidence-based overview regarding the effectiveness of conservative and surgical interventions to treat the frozen shoulder. Methods The Cochrane Library, PubMed, Embase, Cinahl and Pedro were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently selected relevant studies, assessed the methodological quality and extracted data. A best-evidence synthesis was used to summarise the results. Results Five Cochrane reviews and 18 RCTs were included studying the effectiveness of oral medication, injection therapy, physiotherapy, acupuncture, arthrographic distension and suprascapular nerve block (SSNB). Conclusions We found strong evidence for the effectiveness of steroid injections and laser therapy in short-term and moderate evidence for steroid injections in mid-term follow-up. Moderate evidence was found in favour of mobilisation techniques in the short and long term, for the effectiveness of arthrographic distension alone and as an addition to active physiotherapy in the short term, for the effectiveness of oral steroids compared with no treatment or placebo in the short term, and for the effectiveness of SSNB compared with acupuncture, placebo or steroid injections. For other commonly used interventions no or only limited evidence of effectiveness was found. Most of the included studies reported short-term results, whereas symptoms of frozen shoulder may last up to 4 years. High quality RCTs studying long-term results are clearly needed in this field.

The effect of electrical stimulation on recovery from exercise-induced muscle damage. Leeder J, Spence J, Taylor E, Harrison A, Howatson G

British journal of sports medicine 45(15):A21, 2011 Dez The aim was to investigate the efficacy of a commercially available electrical stimulation device purporting to facilitate recovery from strenuous exercise. Eight participants (5 male and 3 female, age range 23-30 y) volunteered for the study and were familiarised with all exercises involved. Prior to damaging exercise, participants completed tests of maximal isometric voluntary contraction of the knee extensors (MIVC-E) and flexors (MIVC-F) of both legs and perception of delayed-onset muscle soreness (DOMS) was ascertained via a 200 mm visual analogue scale. To induce muscle damage, participants completed 5 sets of 20 drop jumps (10 s between jumps, 2 min between sets) from a 60 cm (males) or 40 cm high (females) platform. Electrical stimulation (Bodyflow, Victoria, Australia) was applied at 1.52 Hz for 3×20 min per day, separated by 5 h, for the next 48 h, randomised into either the dominant (n = 4) or non-dominant leg (n = 4), with the contralateral leg acting as the non-treatment control. Participants completed tests of MIVC-E and MIVC-F and a visual analogue scale 24 h and 48 h following the exercise insult. DOMS showed an increase over time (p0.05). At 24 h after exercise, relative reductions in MIVC-E for control and treatment groups were 16±8% and 11±7%, respectively, and at 48 h 8±8% and 5±8%, respectively. Electrical stimulation was not effective at alleviating perceptions of DOMS following muscle damaging exercise, but there was a trend towards accelerated recovery of knee extensor strength. Further research is required to elucidate this finding with a larger and more homogenous sample population.

 

 

Does a 3-month multidisciplinary intervention improve pain, body composition and physical fitness in women with fibromyalgia? Carbonell-Baeza A, Aparicio VA, Ortega FB, Cuevas AM, Alvarez IC, Ruiz JR, Delgado-Fernandez M

British journal of sports medicine 45(15):1189-95, 2011, dezDepartamento de Educación Física y Deportiva, Universidad de Granada, Carretera de Alfacar, s/n, 18011, Granada, Spain. Este endereço de e-mail está protegido de spam bots, pelo que necessita do Javascript activado para o visualizar .

Objective To determine the effects of a 3-month multidisciplinary intervention on pain (primary outcome), body composition and physical fitness (secondary outcomes) in women with fibromyalgia (FM). Methods 75 women with FM were allocated to a low-moderate intensity 3-month (three times/week) multidisciplinary (pool, land-based and psychological sessions) programme (n=33) or to a usual care group (n=32). The outcome variables were pain threshold, body composition (body mass index and estimated body fat percentage) and physical fitness (30 s chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go and 6 min walk test). Results The authors observed a significant interaction effect (group*time) for the left (L) and right (R) side of the anterior cervical (p<0.001) and the lateral epicondyle R (p=0.001) tender point. Post hoc analysis revealed that pain threshold increased in the intervention group (positive) in the anterior cervical R (p<0.001) and L (p=0.012), and in the lateral epicondyle R (p=0.010), whereas it decreased (negative) in the anterior cervical R (p<0.001) and L (p=0.002) in the usual care group. There was also a significant interaction effect for chair sit and reach. Post hoc analysis revealed improvement in the intervention group (p=0.002). No significant improvement attributed to the training was observed in the rest of physical fitness or body composition variables. Conclusions A 3-month multidisciplinary intervention three times/week had a positive effect on pain threshold in several tender points in women with FM. Though no overall improvements were observed in physical fitness or body composition, the intervention had positive effects on lower-body flexibility.

Anton SD et, al. Res Q Exerc Sport, 2 365-70,

Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review (Jan 2011)

Neuromuscular training reduces the risk of lower limb injuries (Jan 2011)

Vibration Training Improves Balance in Unstable Ankles - Int J Sports Med 2010; 31(12): 894-900

Rehabilitation of pediatric musculoskeletal sport-related injuries: a review of the literature.

Cohen E, Sala DA.: European Journal of Physical and Rehabilitation Medicine, 2010, 46(2):133-45. Physical Therapy Department, NYU Hospital for Joint Diseases, New York, NY, USA.

AIM: The recent increase in sports participation in children and adolescents has resulted in the increase of sport-related injuries and the need for rehabilitation. The purposes of this study were to review studies involving rehabilitation of pediatric musculoskeletal sport-related injuries to determine the study design (level of evidence), inclusion of a reference to skeletal immaturity, adequacy of the description of the rehabilitation program and treatment outcome. METHODS: Medline(1950-June 2009), CINAHL(1982-June 2009), Cochrane and journals (sports, physical therapy, pediatric orthopedic) were searched using the terms: physical therapy or rehabilitation plus sports/athletic injuries or individual sports plus pediatrics, adolescent, children, youth and young. Inclusion criteria were: published in English peer-reviewed journal, examined rehabilitation/management,

Rehabilitation following a minimally invasive procedure for the repair of a combined anterior cruciate and posterior cruciate ligament partial rupture in a 15-year-old athlete.

Beecher M, Garrison JC, Wyland D.: The Journal of Orthopaedic and Sports Physical Therapy, 2010, 40(5):297-309. Sports Physical Therapist, Performance Physical Therapy, Cos Cob, CT,USA.

STUDY DESIGN: Case report. BACKGROUND: The healing response procedure is a minimally invasive arthroscopic surgical technique used to stimulate healing in the treatment of partial cruciate ligament tears. The purpose of this report is to provide information on the surgical procedure, the postoperative rehabilitation, and the overall functional results in a patient who underwent such a procedure. CASE DESCRIPTION: A 15-year-old male, who sustained a partial tear of both the anterior cruciate and posterior cruciate ligament while playing football, underwent arthroscopic surgical management utilizing a healing response technique. Precautions concerning range of motion and resisted activities were followed postoperatively to protect the healing cruciate ligaments. The postoperative protocol consisted of 3 phases, culminating in return-to-sport training. Treatment incorporated cardiovascular, proprioceptive, strength, power, plyometric, and sport-specific activities. Treatment was progressed based on specific criteria emphasizing proper movement patterns and eccentric control during functional activities. OUTCOMES: The patient attended 31 physical therapy sessions over 17 weeks. Strength improved from 3/5 to 5/5, knee range of motion returned to normal, Lower Extremity Functional Scale scores improved from 21/80 to 80/80, and successful outcomes on functional return-to-sport testing allowed the patient to return to competitive athletics. DISCUSSION: Primary repair of cruciate ligament tears has yielded poor results, and partial cruciate ligament tears may not require complete surgical reconstruction. The healing response technique offers a possible solution for the treatment of partial cruciate ligament tears. A criterion-based postoperative protocol was derived based on current evidence regarding rehabilitation following cruciate ligament reconstruction and evidence regarding lower extremity rehabilitation principles and injury prevention. LEVEL OF EVIDENCE: Therapy, level 4.

A randomized trial of tai chi for fibromyalgia.

Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, Lee Y, McAlindon T.: The New England Journal of Medicine, 2010, 363(8):743-54. Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.

BACKGROUND: Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia. METHODS: We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response. RESULTS: Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (+/-SD) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8, respectively, versus 68.0+/-11 and 58.6+/-17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, -18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, -18.3 points; P<0.001). No adverse events were observed. CONCLUSIONS: Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008.)

Effects of running retraining after knee anterior cruciate ligament reconstruction

Dauty M, Menu P, Dubois C.: Annals of Physical and Rehabilitation Medicine, 2010, 53(3):150-61. Pôle de médecine physique et réadaptation, hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44035 Nantes cedex 01, France.

Objective: The aim of this study was to analyze the effect of running retraining on the recovery of the knee's functional and muscular properties after anterior cruciate ligament (ACL) reconstruction. Methods: Eighty-five athletes who had undergone ACL reconstruction surgery were selected randomly to receive, or not to receive, controlled running training based on interval training and speed exercises. The effect of retraining was measured by the evolution of the knee's isokinetic strength deficit and progress (at angular speeds of 60 and 180 degrees /s), the knee laxity parameters and the score on the Lysholm Knee Scale from the 4th to the 6th month after the surgery. Forty subjects were retrained and compared with 40 control-group subjects. The effect of the retraining program was studied in terms of the type of ACL reconstruction and the effect of time. Results: After retraining, no difference was found for isokinetic knee strength deficit and progress, knee laxity and Lysholm Knee Score. The isokinetic strength deficit was influenced mainly by the type of ACL reconstruction. Conclusion: It would seem that running retraining has an insufficient effect on the muscular and functional recovery after ACL reconstruction, despite the fact that this type of training is well-tolerated.

Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial.

Hartvigsen J, Morsø L, Bendix T, Manniche C.: BMC Musculoskeletal Disorders, 2010 11:30. Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, Denmark.

BACKGROUND: Active approaches including both specific and unspecific exercise are probably the most widely recommended treatment for patients with chronic low back pain but it is not known exactly which types of exercise provide the most benefit. Nordic Walking - power walking using ski poles - is a popular and fast growing type of exercise in Northern Europe that has been shown to improve cardiovascular metabolism. Until now, no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to back pain. METHODS: A total of 151 patients with low back and/or leg pain of greater than eight weeks duration were recruited from a hospital based outpatient back pain clinic. Patients continuing to have pain greater than three on the 11-point numeric rating scale after a multidisciplinary intervention were included. Fifteen patients were unable to complete the baseline evaluation and 136 patients were randomized to receive A) Nordic walking supervised by a specially trained instructor twice a week for eight weeks B) One-hour instruction in Nordic walking by a specially trained instructor followed by advice to perform Nordic walking at home as much as they liked for eight weeks or C) Individual oral information consisting of advice to remain active and about maintaining the daily function level that they had achieved during their stay at the backcenter. Primary outcome measures were pain and disability using the Low Back Pain Rating Scale, and functional limitation further assessed using the Patient Specific Function Scale. Furthermore, information on time off work, use of medication, and concurrent treatment for their low back pain was collected. Objective measurements of physical activity levels for the supervised and unsupervised Nordic walking groups were performed using accelerometers. Data were analyzed on an intention-to-treat basis. RESULTS: No mean differences were found between the three groups in relation to any of the outcomes at baseline. For pain, disability, and patient specific function the supervised Nordic walking group generally faired best however no statistically significant differences were found. Regarding the secondary outcome measures, patients in the supervised group tended to use less pain medication, to seek less concurrent care for their back pain, at the eight-week follow-up. There was no difference between physical activity levels for the supervised and unsupervised Nordic walking groups. No negative side effects were reported. CONCLUSION: We did not find statistically significant differences between eight weeks of supervised or unsupervised Nordic walking and advice to remain active in a group of chronic low back pain patients. Nevertheless, the greatest average improvement tended to favor the supervised Nordic walking group and - taking into account other health related benefits of Nordic walking - this form of exercise may potentially be of benefit to selected groups of chronic back pain patients.

Muscle activation when performing the chest press and shoulder press on a stable bench vs. a Swiss ball.

Uribe BP, Coburn JW, Brown LE, Judelson DA, Khamoui AV, Nguyen D.: Journal of Strength and Conditioning research / National Strength & Conditioning Association, 201004 24(4):1028-33. Human Performance Laboratory, Department of Kinesiology, California State University, Fullerton, CA, USA.

The aim of this study was to examine the effects of a stable surface (bench) vs. an unstable surface (Swiss ball) on muscle activation when performing the dumbbell chest press and shoulder press. Sixteen healthy men (24.19 +/- 2.17 years) performed 1 repetition maximum (1RM) tests for the chest press and shoulder press on a stable surface. A minimum of 48 hours post 1RM, subjects returned to perform 3 consecutive repetitions each of the chest press and shoulder press at 80% 1RM under 4 different randomized conditions (chest press on bench, chest press on Swiss ball, shoulder press on bench, shoulder press on Swiss ball). Electromyography was used to assess muscle activation of the anterior deltoid, pectoralis major, and rectus abdominus. The results revealed no significant difference in muscle activation between surface types for either exercise. This suggests that using an unstable surface neither improves nor impairs muscle activation under the current conditions. Coaches and other practitioners can expect similar muscle activation when using a Swiss ball vs. a bench.

Active rehabilitation for children who are slow to recover following sport-related concussion.

Gagnon I, Galli C, Friedman D, Grilli L, Iverson GL.: Brain injury : [BI], 200911 23(12):956-64. Montreal Children's Hospital, Montreal, Canada.

PRIMARY OBJECTIVE: To present an innovative approach to the management of children who are slow to recover after a sport-related concussion. Research design: The article describes the underlying principles and the development of specific interventions for a new rehabilitation programme as well as preliminary data on pre- and post-rehabilitation changes in outcome measures. METHODS AND PROCEDURES: Development of the intervention was done using multiple perspectives including that of the literature, of experts in the field of traumatic brain injury and of experienced clinicians involved with the paediatric and adolescent MTBI clientele. A logic model was developed providing sound theoretical background to the intervention. The intervention was implemented and evaluated with a sample of 16 children and adolescents. MAIN OUTCOMES AND RESULTS: The presented cases suggest that involvement in controlled and closely monitored rehabilitation in the post-acute period may promote recovery in children and adolescents who present with atypical recovery following a concussion. All 16 of the children and adolescents who participated in the programme experienced a relatively rapid recovery and returned to their normal lifestyles and sport participation. CONCLUSIONS: A gradual, closely-supervised active rehabilitation programme in the post-acute period (i.e. after 1 month post-injury) appears promising to improve the care provided to children who are slow to recover.

Stationary cycling and children with cerebral palsy: case reports for two participants.

Siebert KL, DeMuth SK, Knutson LM, Fowler EG.: Physical & Occupational Therapy in Pediatrics, 2010, 30(2):125-38. South Bay Medical Therapy Unit, California Children's Services of Los Angeles County, USA.

These case reports describe a stationary cycling intervention and outcomes for two child participants (P1 and P2) with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. P1 exhibited higher training intensities, particularly during the cardiorespiratory phase. Average training heart rates were 59% and 35% of maximum heart rate for P1 and P2, respectively. Lower extremity peak knee flexor and extensor moments, gross motor function (Gross Motor Function Measure (GMFM-66)), preferred walking speed (thirty-second walk test), and walking endurance (600-yard walk-run test) were measured pre- and postintervention. Changes in outcome measurements corresponded with differences in exercise intensity. Greater gains in peak knee extensor moments, GMFM-66 scores (+4.2 versus +0.9), 600-yard walk-run test (-29% versus 0%) occurred for P1 versus P2, respectively. Preferred walking speeds did not increase substantially for P1 and decreased for P2.

Salivary cortisol and immunoglobulin A responses during golf competition vs. practice in elite male and female junior golfers.

Kim KJ, Park S, Kim KH, Jun TW, Park DH, Kim KB.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 2010, 24(3):852-8. Division of Sports Science, Korea Institute of Sport Science, Seoul, Korea.

The purpose of this study was to investigate the stress and immune responses to a competition in elite male and female junior golfers. Six male (16.2 +/- 1.4 years) and 6 female junior golfers (16.4 +/- 1.1 years) completed salivary collections during competition vs. practice rounds on 2 different days. Salivary samples were collected on 4 occasions (rest, before, during, and after rounds). Salivary cortisol and IgA were measured for stress and immune responses, respectively. Our results were as follows: (a) Salivary cortisol level was higher in competition than practice in male golfers (p = 0.009) but it was similar in female golfers. In male golfers, salivary cortisol level was higher before a round than at rest (p = 0.029), but it was higher after rounds than at rest (p = 0.016) in female golfers. (b) Salivary IgA was elevated during competition than during practice rounds in male golfers (p = 0.019), but not in females (p = 0.152). Salivary IgA was not significantly different among salivary collection times although it tended to be elevated during and after rounds for both male and female golfers. In conclusion, salivary cortisol and IgA were elevated during golf competition compared with practice in male junior golfers, but they were not in female golfers. Furthermore, salivary cortisol was higher before a round than rest in men, but it was higher after a round than rest in women. Both male and female junior golfers, however, showed similar salivary IgA responses during golf. Our results suggest that sex might play a role on stress and immune responses during a game of golf in elite junior golfers.

Total hemoglobin mass, iron status, and endurance capacity in elite field hockey players.

Hinrichs T, Franke J, Voss S, Bloch W, Schänzer W, Platen P.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 2010 24(3):629-38. Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany.

The aims of this study were as follows: To evaluate total hemoglobin mass (tHbmass) in international field hockey players; to examine the correlation between tHbmass and maximum oxygen uptake (VO2max); and to assess influences of iron status on tHbmass and on VO2max. The players of the German women's (N = 17, aged 24.8 +/- 3.0 [21-31] years) and men's (N = 17, aged 24.2 +/- 2.9 [19-32] years) national field hockey team were investigated. tHbmass was measured by an optimized carbon monoxide rebreathing method. The following parameters were measured in venous blood: Hemoglobin concentration (Hbconc), hematocrit (Hct), number and percentage of reticulocytes, reticulocyte hemoglobin content, serum iron, serum ferritin, serum transferrin, unsaturated iron-binding capacity, and serum soluble transferrin receptor concentration. VO2max was determined in a treadmill test. tHbmass (women: 10.6 +/- 1.1 g/kg; men: 12.5 +/- 0.9 g/kg) correlated to VO2max (women: 46.6 +/- 2.9 mL/min/kg; men: 55.8 +/- 4.0 mL/min/kg) in women (r = 0.56, p < 0.05) and in men (r = 0.57, p < 0.05), whereas Hbconc and Hct did not. The investigated parameters of iron status showed no association to tHbmass or to VO2max. In conclusion, tHbmass can be used as an indicator for endurance capacity in elite field hockey players, whereas Hbconc may not. tHbmass or VO2max were not influenced by the actual iron status of the investigated athletes.

Accelerated protocol of rehabilitation after anterior cruciate ligament reconstruction with patellar tendon- normative data

Thiele E, Bittencourt L, Osiecki R, Fornaziero AM, Hernadez SG, Nassif PA, Ribas CM.: Revista do Colégio Brasileiro de Cirurgiões, 2009, 36(6):504-8. Faculdade Evangélica do Paraná, Curitiba, PR, Brasil.

OBJECTIVE: evaluate the gotten results of the accelerated protocol adapted to the clinic conditions in CLA post operatory patients. METHODS: 30 patients were selected and submitted to an isokynetic test at the pre operatory and 4 months post operatory. RESULTS: the isokinetics evaluations at the pre operatory presented: flexor peak torque 93% at 60 degrees /s and 97,3% at 180 degrees /s. Extensor 87,3% at 60 degrees /s and 94,7% at 180 degrees /s; power of the flexor muscles of 93,3% and extensors of 96,7%; the muscular work of the flexors was of 91,7% and extensors of 90,3%; the flexor peak torque angle was at 28,7 degrees . At the extensor musculature the angle was at 62,2 degrees ; flexors eccentric peak torque of 78,3% and the extensors of 12,8%. With 4 months of post operatory the gotten results showed: flexor peak torque 95,4% at 60 degrees /s and 97,1%. at 180 degrees /s; extensor 70% at 60 degrees /s and 75,7%. at 180 degrees /s; power of the flexor muscles of 97,1% and extensors of 79,8%; the muscular work of the flexors was of 94,2% and extensors of 94,2%; flexors eccentric peak torque of 84% and extensors of 24,2%; the flexor peak torque angle was at 27,3 degrees ; in extensor musculature the angle was at 61,7 degrees . CONCLUSION: showed that the patients treated with the adapted protocol presented similar results to the original protocol in relation to the muscular conditions.

Stabilité posturale après reconstruction du ligament croisé antérieur

J.P. Pinheiro, I. Campos, C. Amaral, J.P. Branco, P. Figueiredo, N. Figueiral, P. Lemos and S. Ramos: Journal de Traumatologie du Sport, Volume 27, Issue 2, June 2010, Pages 73-76. Universidade de Coimbra, Faculdade de Medicina, Médecine physique et de réadaptation, Hospitais da Universidade de Coimbra, Portugal; Médecine physique et de réadaptation, Hospitais da Universidade de Coimbra, Portugal.

Injury of the anterior cruciate ligament (ACL) leads to static and dynamic instability, with a risk of joint degeneration. The purpose of surgical reconstruction is to re-establish joint stability and function. It does not restore the sensorial system. The purpose of this work was to compare, in terms of postural stability, healthy knees and operated knees five years after ligamentoplasty versus 31. A dynamic posturography device was used for assessment. It was concluded that there was no difference between the two groups concerning postural stability.

Neuromuscular electrical stimulation training: a safe and effective treatment for facioscapulohumeral muscular dystrophy patients.

Colson SS, Benchortane M, Tanant V, Faghan JP, Fournier-Mehouas M, Benaïm C, Desnuelle C, Sacconi S.: Archives of Physical Medicine and Rehabilitation, 201005 91(5):697-702. University of Nice-Sophia Antipolis, Laboratory of Human Motricity, Education, and Health, Faculty of Sports Sciences, Nice Cedex, France.

Objective: To investigate the feasibility, safety, and effectiveness of neuromuscular electrical stimulation (NMES) Strength training in facioscapulohumeral muscular dystrophy (FSHD) patients. Design: Uncontrolled before-after trial. Setting: Neuromuscular disease center in a university hospital and a private-practice physical therapy office. Participants: FSHD patients (N=9; 3 women, 6 men; age 55.2+/-10.4y) clinically characterized by shoulder girdle and quadriceps femoris muscle weakness. Interventions : Patients underwent 5 months of Strength training with NMES bilaterally Applied to the deltoideus, trapezius transversalis, vastus lateralis, and vastus medialis muscles for five 20-minute sessions per week. Main outcome measures: Plasma creatine kinase (CK) activity; scores for pain and fatigue on visual analog scales (VAS), manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), 6-minute walking tests (6MWT), and self-reported changes in daily living activities. Results: NMES Strength training was well tolerated (CK activity and pain and fatigue scores on VAS were not modified). Most of the muscle functions (shoulder flexion and extension and knee extension) assessed by MMT were significantly increased. MVIC of shoulder flexion and abduction and the 6MWT distance were also improved. Conclusions : In FSHD, NMES Strength training appears to be safe with positive effects on muscle function, strength, and capacity for daily activities.

Pilates for improvement of muscle endurance, flexibility, balance, and posture.

Kloubec JA.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 201003 24(3):661-7. Department of Health and Exercise Science, Gustavus Adolphus College, St. Peter, Minnesota, USA.

Many claims have been made about the effectiveness of Pilates exercise on the basic parameters of fitness. The Purpose of this study was to determine the effects of Pilates exercise on abdominal endurance, hamstring flexibility, upper-body muscular endurance, posture, and balance. Fifty subjects were recruited to participate in a 12-week Pilates class, which met for 1 hour 2 times per week. Subjects were randomly assigned to either the experimental (n = 25) or control group (n = 25). Subjects performed the essential (basic) mat routine consisting of approximately 25 separate exercises focusing on muscular endurance and flexibility of the abdomen, low back, and hips each class session. At the end of the 12-week period, a 1-way analysis of covariance showed a significant level of improvement (p < or = 0.05) in all variables except posture and balance. This study demonstrated that in active middle-aged men and women, exposure to Pilates exercise for 12 weeks, for two 60-minute sessions per week, was enough to promote statistically significant increases in abdominal endurance, hamstring flexibility, and upper-body muscular endurance. Participants did not demonstrate improvements in either posture or balance when compared with the control group. Exercise-training programs that address physical inactivity concerns and that are accessible and enjoyable to the general public are a desirable commodity for exercise and fitness trainers. This study suggests that individuals can improve their muscular endurance and flexibility using relatively low-intensity Pilates exercises that do not require equipment or a high degree of skill and are easy to master and use within a personal fitness routine.

Rehabilitation of the hip following sports injury.

Tyler TF, Slattery AA.: Clinics in Sports Medicine, 201001 29(1):107-26, table of contents. NISMAT at Lenox Hill Hospital, New York, NY 10021, USA.

An athlete often presents to the rehabilitation specialist with either a nonspecific referral, such as "hip pain," or with a diagnosis of a more specific hip pathology. The highly skilled clinician is trained to look at the "linkage" between the trunk and all parts of the lower extremity. Why is the hip not transferring the load well? Where is the breakdown? The gluteus medius, pelvic stability, and supportive muscular slings are of great importance when optimizing the function of the hip. The hip is subjected to forces equal to multiples of the body weight and requires osseous, articular and myofascial integrity for stability. This is the mind set when devising an athlete's rehabilitative program, looking at all influential factors that affect joint movement and integrity.

Salivary cortisol and immunoglobulin A responses during golf competition vs. practice in elite male and female junior golfers.

Kim KJ, Park S, Kim KH, Jun TW, Park DH, Kim KB.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 201003 24(3):852-8. Division of Sports Science, Korea Institute of Sport Science, Seoul, Korea.

The Purpose of this study was to investigate the stress and immune responses to a competition in elite male and female junior golfers. Six male (16.2 +/- 1.4 years) and 6 female junior golfers (16.4 +/- 1.1 years) completed salivary collections during competition vs. practice rounds on 2 different days. Salivary samples were collected on 4 occasions (rest, before, during, and after rounds). Salivary cortisol and IgA were measured for stress and immune responses, respectively. Our results were as follows: (a) Salivary cortisol level was higher in competition than practice in male golfers (p = 0.009) but it was similar in female golfers. In male golfers, salivary cortisol level was higher before a round than at rest (p = 0.029), but it was higher after rounds than at rest (p = 0.016) in female golfers. (b) Salivary IgA was elevated during competition than during practice rounds in male golfers (p = 0.019), but not in females (p = 0.152). Salivary IgA was not significantly different among salivary collection times although it tended to be elevated during and after rounds for both male and female golfers. In conclusion, salivary cortisol and IgA were elevated during golf competition compared with practice in male junior golfers, but they were not in female golfers. Furthermore, salivary cortisol was higher before a round than rest in men, but it was higher after a round than rest in women. Both male and female junior golfers, however, showed similar salivary IgA responses during golf. Our results suggest that sex might play a role on stress and immune responses during a game of golf in elite junior golfers.

Total hemoglobin mass, iron status, and endurance capacity in elite field hockey players.

Hinrichs T, Franke J, Voss S, Bloch W, Schänzer W, Platen P.: Journal of Strength and Conditioning Research / National Strength & Conditioning Association.: 201003 24(3):629-38. Department of Sports Medicine and Sports Nutrition, Ruhr-University of Bochum, Bochum, Germany.

The aims of this study were as follows: To evaluate total hemoglobin mass (tHbmass) in international field hockey players; to examine the correlation between tHbmass and maximum oxygen uptake (VO2max); and to assess influences of iron status on tHbmass and on VO2max. The players of the German women's (N = 17, aged 24.8 +/- 3.0 [21-31] years) and men's (N = 17, aged 24.2 +/- 2.9 [19-32] years) national field hockey team were investigated. tHbmass was measured by an optimized carbon monoxide rebreathing method. The following parameters were measured in venous blood: Hemoglobin concentration (Hbconc), hematocrit (Hct), number and percentage of reticulocytes, reticulocyte hemoglobin content, serum iron, serum ferritin, serum transferrin, unsaturated iron-binding capacity, and serum soluble transferrin receptor concentration. VO2max was determined in a treadmill test. tHbmass (women: 10.6 +/- 1.1 g/kg; men: 12.5 +/- 0.9 g/kg) correlated to VO2max (women: 46.6 +/- 2.9 mL/min/kg; men: 55.8 +/- 4.0 mL/min/kg) in women (r = 0.56, p < 0.05) and in men (r = 0.57, p < 0.05), whereas Hbconc and Hct did not. The investigated parameters of iron status showed no association to tHbmass or to VO2max. In conclusion, tHbmass can be used as an indicator for endurance capacity in elite field hockey players, whereas Hbconc may not. tHbmass or VO2max were not influenced by the actual iron status of the investigated athletes.

Accelerated protocol of rehabilitation after anterior cruciate ligament reconstruction with patellar tendon- normative data

Thiele E, Bittencourt L, Osiecki R, Fornaziero AM, Hernadez SG, Nassif PA, Ribas CM.: Revista do Colégio Brasileiro de Cirurgiões, 200912 36(6):504-8. Faculdade Evangélica do Paraná, Curitiba, PR, Brasil.

Objective: evaluate the gotten results of the accelerated protocol adapted to the clinic conditions in CLA post operatory patients. Methods: 30 patients were selected and submitted to an isokynetic test at the pre operatory and 4 months post operatory. Results: the isokinetics evaluations at the pre operatory presented: flexor peak torque 93% at 60 degrees /s and 97,3% at 180 degrees /s. Extensor 87,3% at 60 degrees /s and 94,7% at 180 degrees /s; power of the flexor muscles of 93,3% and extensors of 96,7%; the muscular work of the flexors was of 91,7% and extensors of 90,3%; the flexor peak torque angle was at 28,7 degrees . At the extensor musculature the angle was at 62,2 degrees ; flexors eccentric peak torque of 78,3% and the extensors of 12,8%. With 4 months of post operatory the gotten results showed: flexor peak torque 95,4% at 60 degrees /s and 97,1%. at 180 degrees /s; extensor 70% at 60 degrees /s and 75,7%. at 180 degrees /s; power of the flexor muscles of 97,1% and extensors of 79,8%; the muscular work of the flexors was of 94,2% and extensors of 94,2%; flexors eccentric peak torque of 84% and extensors of 24,2%; the flexor peak torque angle was at 27,3 degrees ; in extensor musculature the angle was at 61,7 degrees . Conclusion: showed that the patients treated with the adapted protocol presented similar results to the original protocol in relation to the muscular conditions.

Modificado em 16 de Junho de 2010

Ergometer cycling after hip or knee replacement surgery: a randomized controlled trial.

Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J.: The Journal of Bone and Joint Surgery. American volume. 2010 Abril 92(4):814-22. Department of Orthopaedic Surgery, University of Schleswig-Holstein Medical Center, Campus Kiel, Michaelisstrasse 1, 24105 Kiel, Germany.

Background: The optimal treatment strategy following primary total hip or knee replacement remains unknown. The purpose of this study was to evaluate the effect of ergometer cycling after hip or knee replacement surgery on health-related quality of life and patient satisfaction. Methods: Three hundred and sixty-two patients were randomly assigned to either perform or not perform ergometer cycling beginning two weeks after total hip or knee replacement. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at three, six, twelve, and twenty-four months postoperatively. Results were compared with published thresholds for minimal clinically important improvements. Results: The baseline characteristics of the two groups were similar. After the hip arthroplasties, all of the outcome parameters were superior in the ergometer cycling group at all follow-up intervals, and the primary outcome, physical function as measured with the WOMAC, was significantly better at three months (21.6 compared with 16.4 points, effect size = 0.33, p = 0.046) and twenty-four months (14.7 compared with 9.0 points, effect size = 0.37, p = 0.019). After the hip arthroplasties, a higher percentage of the ergometer cycling group was "very satisfied" at all follow-up intervals (for example, 92% compared with 80% at three months; p = 0.027). The significant differences in the primary outcome exceeded the absolute minimal clinically important improvement threshold by a factor of 2.0. No significant differences between the study groups were seen after the knee arthroplasties. Conclusions: Ergometer cycling after total hip arthroplasty is an effective means of achieving significant and clinically important improvement in patients' early and late health-related quality of life and satisfaction. However, this study does not support the use of ergometer cycling after knee arthroplasty.

Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report.

Tonley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM.: The Journal of Orthopaedic and Sports Physical Therapy, 2010, 40(2):103-11. Department of Physical Medicine and Rehabilitation, Kaiser Permanente West Los Angeles, Los Angeles, CA, USA.

Study design: Case report. Objective: To describe an alternative treatment approach for piriformis syndrome using a hip muscle strengthening program with movement reeducation. Background: Interventions for piriformis syndrome typically consist of stretching and/or soft tissue massage to the piriformis muscle. The premise underlying this approach is that a shortening or "spasm" of the piriformis is responsible for the compression placed upon the sciatic nerve. Case Description: The patient was a 30-year-old male with right buttock and posterior thigh pain for 2 years. Clinical findings upon examination included reproduction of symptoms with palpation and stretching of the piriformis. Movement analysis during a single-limb step-down revealed excessive hip adduction and internal rotation, which reproduced his symptoms. Strength assessment revealed weakness of the right hip abductor and external rotator muscles. The patient's treatment was limited to hip-strengthening exercises and movement reeducation to correct the excessive hip adduction and internal rotation during functional tasks. Outcomes: Following the intervention, the patient reported 0/10 pain with all activities. The initial Lower Extremity Functional Scale questionnaire score of 65/80 improved to 80/80. Lower extremity kinematics for peak hip adduction and internal rotation improved from 15.9 degrees and 12.8 degrees to 5.8 degrees and 5.9 degrees, respectively, during a step-down task. Discussion: This case highlights an alternative view of the pathomechanics of piriformis syndrome (overstretching as opposed to overshortening) and illustrates the need for functional movement analysis as part of the examination of these patients.

The use of instability to train the core musculature.

Behm DG, Drinkwater EJ, Willardson JM, Cowley PM.: Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquée, Nutrition et Métabolisme, 2010 35(1):91-108. School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL A1C 5S7, Canada.

Training of the trunk or core muscles for enhanced health, rehabilitation, and athletic performance has received renewed emphasis. Instability resistance exercises have become a popular means of training the core and improving balance. Whether instability resistance training is as, more, or less effective than traditional ground-based resistance training is not fully resolved. The purpose of this review is to address the effectiveness of instability resistance training for athletic, nonathletic, and rehabilitation conditioning. The anatomical core is defined as the axial skeleton and all soft tissues with a proximal attachment on the axial skeleton. Spinal stability is an interaction of passive and active muscle and neural subsystems. Training programs must prepare athletes for a wide variety of postures and external forces, and should include exercises with a destabilizing component. While unstable devices have been shown to be effective in decreasing the incidence of low back pain and increasing the sensory efficiency of soft tissues, they are not recommended as the primary exercises for hypertrophy, absolute strength, or power, especially in trained athletes. For athletes, ground-based free-weight exercises with moderate levels of instability should form the foundation of exercises to train the core musculature. Instability resistance exercises can play an important role in periodization and rehabilitation, and as alternative exercises for the recreationally active individual with less interest or access to ground-based free-weight exercises. Based on the relatively high proportion of type I fibers, the core musculature might respond well to multiple sets with high repetitions (e.g., >15 per set); however, a particular sport may necessitate fewer repetitions.

Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings.

Wagner T, Behnia N, Ancheta WK, Shen R, Farrokhi S, Powers CM.: The Journal of Orthopaedic and Sports physical Therapy, 2010, 40(2):112-9. Kaiser Permanente Southern California Orthopaedic Physical Therapy Residency Program, Woodland Hills, CA, USA.

Study design: Case report. Objective: To highlight the effects of an intervention program consisting of strengthening and neuromuscular reeducation of the gluteus maximus in an elite triathlete with exercise-associated muscle cramping (EAMC). Background: Researchers have described 2 theories concerning the etiology of EAMC: (1) muscle fatigue and (2) electrolyte deficit. As such, interventions for EAMC typically consist of stretching/strengthening of the involved muscle and/or supplements to restore electrolyte imbalances. Case Description: The patient was a 42-year-old male triathlete with a primary complaint of recurrent cramping of his right hamstring muscle, which prevented him from completing races at his desired pace. Strength testing revealed gluteus maximus muscle weakness bilaterally. Electromyographic (EMG) analysis (surface electrodes, 1560 Hz) revealed that the right hamstrings were being activated excessively during terminal swing and the first half of the stance phase (48.1% maximum voluntary isometric contraction [MVIC]). Outcomes: Following the intervention, the patient was able to complete 3 triathlons without hamstring cramping. Strength testing revealed that the right hip extension strength improved from 35.6 to 54.7 kg, and activation of the hamstrings during terminal swing and the first half of the stance phase decreased to 36.4% of MVIC. Discussion: A program of gluteus maximus strengthening and neuromuscular training eliminated EAMC of the hamstrings in this patient. Given that the hamstrings and gluteus maximus work as agonists to decelerate the thigh during terminal swing phase and control hip flexion during loading response of running, we postulate that strengthening of the gluteus maximus decreased the relative effort required by the hamstrings, thus reducing EAMC. The results of the EMG evaluation that was performed as part of this case report provides support for this hypothesis.

Canadian Society for Exercise Physiology position stand: The use of instability to train the core in athletic and nonathletic conditioning.

Behm DG, Drinkwater EJ, Willardson JM, Cowley PM.: Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquée, Nutrition et Metabolism, 2010, 35(1):109-12. School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL A1C 5S7, Canada.

The use of instability devices and exercises to train the core musculature is an essential feature of many training centres and programs. It was the intent of this position stand to provide recommendations regarding the role of instability in resistance training programs designed to train the core musculature. The core is defined as the axial skeleton and all soft tissues with a proximal attachment originating on the axial skeleton, regardless of whether the soft tissue terminates on the axial or appendicular skeleton. Core stability can be achieved with a combination of muscle activation and intra-abdominal pressure. Abdominal bracing has been shown to be more effective than abdominal hollowing in optimizing spinal stability. When similar exercises are performed, core and limb muscle activation are reported to be higher under unstable conditions than under stable conditions. However, core muscle activation that is similar to or higher than that achieved in unstable conditions can also be achieved with ground-based free-weight exercises, such as Olympic lifts, squats, and dead lifts. Since the addition of unstable bases to resistance exercises can decrease force, power, velocity, and range of motion, they are not recommended as the primary training mode for athletic conditioning. However, the high muscle activation with the use of lower loads associated with instability resistance training suggests they can play an important role within a periodized training schedule, in rehabilitation programs, and for nonathletic individuals who prefer not to use ground-based free weights to achieve musculoskeletal health benefits.

Concentric evertor strength differences and functional ankle instability: a meta-analysis.

Arnold BL, Linens SW, de la Motte SJ, Ross SE.: Journal of Athletic Training, 2009, 44(6):653-62. Virginia Commonwealth University, 1015 West Main Street, PO Box, 842020, Richmond, VA 23284-2020, USA.

Objective: To determine whether concentric evertor muscle weakness was associated with functional ankle instability (FAI). Data sources: We conducted an electronic search through November 2007, limited to English, and using PubMed, Pre-CINAHL, CINAHL, and SPORTDiscus. A forward search was conducted using the Science Citation Index on studies from the electronic search. Finally, we conducted a hand search of all selected studies and contacted the respective authors to identify additional studies. We included peer-reviewed manuscripts, dissertations, and theses. Study design: We evaluated the titles and abstracts of studies identified by the electronic searches. Studies were selected by consensus and reviewed only if they included participants with FAI or chronic ankle instability and strength outcomes. Studies were included in the analysis if means and SDs (or other relevant statistical information, such as P values or t values and group n's) were reported for FAI and stable groups (or ankles). Data extraction: Data were extracted by the authors independently, cross-checked for accuracy, and limited to outcomes of concentric eversion strength. We rated each study for quality. Outcomes were coded as either fast or slow velocity (ie, equal to or greater than 110 degrees /s or less than 110 degrees /s, respectively). Data synthetisis: Data included the means, SDs, and group sample sizes (or other appropriate statistical information) for the FAI and uninjured groups (or ankles). The standard difference in the means (SDM) for each outcome was calculated using the pooled SD. We tested individual and overall SDMs using the Z statistic and comparisons between fast and slow velocities using the Q statistic. Our analysis revealed that ankles with FAI were weaker than stable ankles (SDM = 0.224, Z = 4.0, P < .001, 95% confidence interval = 0.115, 0.333). We found no difference between the fast- and slow-velocity SDMs (SDM(Fast) = 0.189, SDM(Slow) = 0.244, Q = 29.9, df = 24, P = .187). Because of the small SDM, this method of measuring ankle strength in the clinical setting may need to be reevaluated.

Eccentric calf muscle exercise produces a greater acute reduction in Achilles tendon thickness than concentric exercise.

Grigg NL, Wearing SC, Smeathers JE

. British Journal of Sports Medicine, 43(4):280-3, 2009.

Institute of Health and Biomedical Innovation,Queensland University of Technology, Brisbane, Australia.

Objective: To investigate the acute effects of isolated eccentric and concentric calf muscle exercise on Achilles tendon sagittal thickness. Design: Within-subject, counterbalanced, mixed design. Setting: Institutional. Participants: 11 healthy, recreationally active male adults. Interventions: Participants performed an exercise protocol, which involved isolated eccentric loading of the Achilles tendon of a single limb and isolated concentric loading of the contralateral, both with the addition of 20% bodyweight. Main outcome measurements: Sagittal sonograms were acquired prior to, immediately following and 3, 6, 12 and 24 h after exercise. Tendon thickness was measured 2 cm proximal to the superior aspect of the calcaneus. Results: Both loading conditions resulted in an immediate decrease in normalised Achilles tendon thickness. Eccentric loading induced a significantly greater decrease than concentric loading despite a similar impulse (-0.21 vs -0.05, p<0.05). Post-exercise, eccentrically loaded tendons recovered exponentially, with a recovery time constant of 2.5 h. The same exponential function did not adequately model changes in tendon thickness resulting from concentric loading. Even so, recovery pathways subsequent to the 3 h time point were comparable. Regardless of the exercise protocol, full tendon thickness recovery was not observed until 24 h. Conclusions: Eccentric loading invokes a greater reduction in Achilles tendon thickness immediately after exercise but appears to recover fully in a similar time frame to concentric loading.

Eccentric loading for Achilles tendinopathy--strengthening or stretching?

Allison GT, Purdam C

. British journal of sports medicine, 43(4):276-9, 2009. School of Physiotherapy, Curtin University, Perth, Western Australia.

The prescription of eccentric loading is considered as a mainstay of non-operative rehabilitation programmes for mid-substance chronic Achilles tendinopathy. Such exercises have some degree of clinical utility in comparison with concentric training and are often referred to as a strengthening programme. Yet the dose parameters of the eccentric loading do not reflect an optimal strengthening programme and specifically avoid the normal eccentric-concentric coupling typical of the stretch shortening cycle. This manuscript identifies the arguments and counterarguments for why eccentric loading rehabilitation is not an optimal strengthening programme. It is proposed that such exercises reflect a specific stretching programme directed at the passive structures. This has two important clinical implications. Firstly, this reinterpretation of the role of eccentric exercises may direct future research into the underlying mechanisms of tendinopathy and, secondly, it may reinforce the importance of adjunct sports specific strengthening programmes.

Performance-based functional evaluation of non-operative and operative treatment after anterior cruciate ligament injury.

Moksnes H, Risberg MA. Scandinavian journal of medicine & science in sports, 19(3):345-55, 2009. NAR Orthopaedic Centre, Ullevaal University Hospital, Oslo, Norway.

Highly active anterior cruciate ligament (ACL)-injured patients are usually recommended surgical treatment as the primary intervention. The objective of this study was to compare the functional outcome in a cohort of individuals after non-operative treatment to individuals after surgical treatment at a 1-year follow-up. One hundred and twenty-five subjects with a mean age of 27.2 years (+/-8.6 years), and participating in level I or II activities were included. Baseline and 1-year follow-up examination included four single-legged hop tests, IKDC 2000, KOS-ADLS, KT-1000 knee arthrometer measurement, VAS, episodes of giving way, and activity level. Fifty-one percent went through non-operative treatment. Non-operated subjects performed significantly better on two of the four single-legged hop tests compared with the ACL-reconstructed subjects at the 1-year follow-up. No other differences were observed. Both groups performed an average >90% compared with their uninjured leg on all single-legged hop tests at the 1-year follow-up. The IKCD 2000 scores in the non-operated and ACL-reconstructed group were on average 86 and 87. ACL-injured subjects should be informed of the possibility of success after non-operative treatment, but future studies are needed to determine significant predictive factors for success for non-operative and surgically treated individuals..

Body weight-supported treadmill training for patients with hip fracture: a feasibility study.

Giangregorio LM, Thabane L, Debeer J, Farrauto L, McCartney N, Adachi JD, Papaioannou A.: Archives of physical medicine and rehabilitation, 90(12):2125-30, 2009.

Department of Kinesiology, University of Waterloo, Waterloo, and Toronto Rehabilitation Institute, Toronto, Canada.

Body weight-supported treadmill training for patients with hip fracture: a feasibility study. Objective: To determine the feasibility of body weight-supported treadmill training (BWSTT) as a strategy for improving independent ambulation among patients who had sustained a hip fracture. Design: Nonrandomized controlled trial. Stting: Inpatient rehabilitation. Participants: Patients with a stable hip fracture and at least 50% weight-bearing. Intervention: BWSTT in lieu of standard walking exercises throughout stay in rehabilitation. Main outcome measures: Feasibility outcomes included the number of patients agreeing to participate in treadmill walking, the number who returned for follow-up assessments, compliance, and the number of adverse events. Secondary outcomes included the Lower Extremity Functional Scale, the Timed Up & Go test, a 2-minute walk test, and the Falls Self-Efficacy Scale. Univariate regression was used to assess the group effect on score changes from baseline to discharge and from baseline to follow-up. Results: Among 41 potentially eligible patients, 21 (51%) agreed to participate and 14 returned for follow-up assessments. The recruitment goal of 12 patients agreeing to BWSTT was achieved; however, retention by 3-month follow-up was 67%. The average compliance was 3 sessions a week; however, several patients were below average. No adverse events of BWSTT were reported. There were no significant differences between groups with respect to secondary outcomes. Conclusions: BWSTT may be a feasible method for retraining gait among patients with hip fracture. However, future studies evaluating its efficacy need rigorous methods for ensuring compliance and retention.

Cross-sectional investigation of indices of isokinetic leg strength in youth soccer players and untrained individuals.

Iga J, George K, Lees A, Reilly T

.: Scandinavian Journal of Medicine & Science in Sports, 19(5):714-9, 2009.

Faculty of Sport, Health and Social Care, University of Gloucestershire, Gloucestershire, UK.

In this cross-sectional study, the differences in the isokinetic peak torque of the knee joint muscles (dominant and non-dominant) were investigated in three groups of youths (n=45; age, 14.9+/-1.1 years) with different soccer training backgrounds. Significant main effects were observed for training background on the functional hamstrings to quadriceps ratios for knee flexion (H(CON):Q(ECC) ratio; F(2,42)=4.023, P=0.025) and extension (H(ECC):Q(CON) ratio; F(2,42)=8.53, P<0.001) at 4.32 rad/s. Post hoc tests indicated that both ratios were significantly different between conventionally trained players compared with resistance-trained players and controls (mean+/-SD; H(ECC):Q(CON) ratio, dominant limb; 0.91+/-0.10; 1.04+/-0.12; 1.10+/-0.22; non-dominant limb; 0.89+/-0.09; 1.05+/-0.19; 1.06+/-0.15; H(CON):Q(ECC) ratio, dominant limb; 0.36+/-0.06; 0.34+/-0.07; 0.30+/-0.08; non-dominant limb; 0.33+/-0.05; 0.32+/-0.08; 0.28+/-0.07). Results suggest that the muscle-loading patterns experienced in youth soccer may alter the reciprocal balance of strength about the knee under high-velocity conditions. The findings also indicate that these balances may be improved by incorporating resistance training into the habitual exercise routines of youth soccer players.

Changes in activities of daily living, physical fitness, and depressive symptoms after six-month periodic well-rounded exercise programs for older adults living in nursing homes or special nursing facilities. Ouyang, P., Yatsuya, H., et al: Nagoya Journal of Medical Science, 71(3-4), 115-26, 2009.Department of Public Health/Health Information Dynamics, Field of Social Life Science, Nagoya University Graduate School of Medicine, Japan.A 6-month, twice weekly, well-rounded exercise program (47 sessions in total) comprised of a combination of aerobic, resistance and flexibility training was provided for institutionalized older adults aged 60 to 93. We analyzed the data of 18 older adults who could stand and had attended more than 10% of the classes (mean participation rate: 54%) to examine changes in activities of daily living (ADL), physical fitness tests and depressive moods. The mean (+/- standard deviation, range) age of the participants was 71.3 (+/- 15.6, 60-93) in men and 85.9 (+/- 5.8, 72-93) in women. Significant improvement in ADL of the hand manipulation domain and borderline significant improvement in ADL of the mobility domain were observed (McNemar test p = 0.011 and 0.072, respectively). A 6-minute walk distance increased significantly from 151.6 m to 236.6 m (p = 0.01, paired t-test), and the result of the Soda Pop test, which tests hand-eye coordination, also improved significantly from 35.2 sec to 25.3 sec (p = 0.01, paired t-test). These findings suggest that such a program could be effective in improving the ADL and physical fitness of the elderly.

Whole-body vibration improves walking function in individuals with spinal cord injury: a pilot study. Ness, L. L., Field-fote, E. C.: The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA. Gait & posture, 30(4):436-40, 2009. Injury to the central nervous system often results in impairments that negatively affect walking function. Prior evidence suggests that vibration may improve walking function. The purpose of this study was to determine whether repeated use of whole-body vibration (WBV) is associated with improvements in walking function in individuals with spinal cord injury (SCI). Subjects were 17 individuals with chronic (> or = 1 year), motor-incomplete SCI. Subjects were tested before and after participation in a 12-session (3 days/week for 4 weeks) intervention of WBV. We assessed change in walking function via 3D motion capture, with walking speed as the primary outcome measure. We also assessed the influence of the WBV intervention on secondary gait characteristics, including cadence, step length, and hip-knee intralimb coordination. Walking speed increased by a mean of 0.062+/-0.011 m/s, a change that was statistically significant (p<0.001). The WBV intervention was also associated with statistically significant increases in cadence, and both the stronger and weaker legs exhibited increased step length and improved consistency of intralimb coordination. Changes in cadence and step length of the stronger leg were strongly correlated with improvements in walking speed. The improvement in walking speed observed with the WBV intervention was comparable to that reported in the literature in association with locomotor training. This magnitude of change has been identified as being clinically meaningful, even in non-clinical populations. These findings suggest WBV may be useful to improve walking function with effects that may persist for some time following the intervention.