Ανασκόπηση βιβλιογραφίας: Όπως υποστηρίζεται από διάφορες έρευνες οι μυς της οσφυϊκής χώρας και συγκεκριμένα ο πολυσχιδής μυς, παίζουν σημαντικό ρόλο στη σταθερότητα της σπονδυλικής στήλης. Προηγούμενες εργασίες που μελέτησαν τα χαρακτηριστικά του πολυσχιδή μυός σε ασθενείς με οσφυαλγία δεν έχουν συμπεριλάβει στο σχεδιασμό τους την παράμετρο της φυσικής δραστηριότητας. Σκοπός της παρούσας έρευνας ήταν να εξετάσει την διάμετρο και την ποσοστιαία αναλογία των μυϊκών ινών του πολυσχιδή μυός μεταξύ ομάδων ασθενών με οσφυαλγία διαφορετικού επιπέδου φυσικής δραστηριότητας και υγιών ατόμων. Μεθοδολογία: Στη μελέτη συμμετείχαν εθελοντικά 64 ασθενείς με οσφυαλγία. Βασιζόμενοι στο επίπεδο φυσικής δραστηριότητας των ασθενών, το οποίο εκτιμήθηκε με την συμπλήρωση συγκεκριμένου ερωτηματολογίου (IPAQ), δημιουργήθηκαν τρεις (3) ερευνητικές ομάδες. Η διαχωρισμός των τριών ομάδων έγινε ανάλογα με το επίπεδο φυσικής δραστηριότητας ως εξής: χαμηλή (ΧΦΔ), μέση (ΜΦΔ), υψηλή (ΥΦΔ). Επίσης στον σχεδιασμό της έρευνας συμπεριελήφθη μια ομάδα ελέγχου αποτελούμενη από 17 άτομα. Βιοπτικό υλικό, διαστάσεων περίπου 5Χ5Χ10 χιλ., ελήφθη από τον πολυσχιδή μυ στο επίπεδο Ο4-Ο5. Αποτελέσματα: Αντίθετα με την ομάδα ελέγχου, οι ομάδες ασθενών με οσφυαλγία παρουσίασαν στατιστικώς μεγαλύτερη ποσοστιαία αναλογία μυϊκών ινών Τύπου ΙΙ καθώς και μικρότερη διάμετρο και στους δύο τύπους ινών (p<0.05). Τα αποτελέσματα έδειξαν ότι το επίπεδο φυσικής δραστηριότητας δεν επηρέασε τα χαρακτηριστικά του πολυσχιδή μυ καθώς δεν παρατηρήθηκαν σημαντικές διαφορές (p>0.05) στη διάμετρο και ποσοστιαία αναλογία των ινών μεταξύ των ομάδων ΥΦΔ, ΜΦΔ και ΧΦΔ. Διάφορες ιστοπαθολογικές αλλοιώσεις που παρατηρήθηκαν ήταν εμφανέστερες στις ομάδες ασθενών με οσφυαλγία συγκριτικά με την ομάδα ελέγχου (p<0.05). Η διάμετρος και των δύο τύπων μυϊκών ινών ήταν μεγαλύτερη στους άνδρες σε σχέση με τις γυναίκες (p<0.05). Συμπεράσματα: Τα αποτελέσματα της έρευνας έδειξαν ότι το επίπεδο φυσικής δραστηριότητας μεταξύ των ομάδων ασθενών με οσφυαλγία δεν επηρέασε την διάμετρο και ποσοστιαία αναλογία των μυικών τους ινών. Συμπερασματικά, βάση αυτών των ευρημάτων η έρευνα προτείνει ότι τόσο η φυσική αδράνεια όσο και η υψηλή φυσική δραστηριότητα μπορούν να επιφέρουν αρνητικές επιπτώσεις στα χαρακτηριστικά των ινών του πολυσχιδή μυός. / Background: Previous studies examining the multifidus fiber characteristics among low back pain (LBP) patients have not considered the variable of physical activity. The present study sought to investigate the muscle fiber size and type distribution of the lumbar multifidus muscle among LBP patient groups with different physical activity levels and healthy controls. Methods: 64 patients were assigned to one of three groups named according to the physical activity level, determined for each patient by the IPAQ questionnaire. These were low (LPA), medium (MPA) and high (HPA) physical activity groups. A control group comprising of 17 healthy individuals was also recruited. Muscle biopsy samples were obtained from the multifidus muscle at the level L4-L5. Results: In contrast with the control group, LBP patient groups showed a significantly higher Type II fiber distribution as well as reduced diameter in both fiber types (p<0.05). The physical activity level did not have an effect on multifidus characteristics since no significant differences were observed in fiber type and diameter (p>0.05) among LPA, MPA and HPA patient groups. Various pathological conditions were detected which were more pronounced in LBP groups compared to the control (p<0.05). Males had a larger fiber diameter compared to females for both fiber types (p<0.05). Conclusion: The results showed that the level of physical activity did not affect muscle fiber size and type distribution among LBP patients groups. These findings suggest that not only inactivity but also high physical activity levels can have an adverse effect on the multifidus muscle fiber characteristics.

This dissertation aims at verifying methodology used for somatographic evaluation of the shape and statics of the spine. The potential of the methodology verified lies in increased objectivity of upright body posture evaluation and thereby contributes to the specification of preventative measures for postural defects, and their consequences. Under a cross-sectional pilot study, a non-invasive somatographic method-a diagnostic DPT-3 system designated for spine shape diagnostics-was used to examine selected biomechanical parameters (spinal curves and statics in the sagittal plane in the upright position) in a total of 508 probands. Of this, 326 were school-age children and 182 adults. Among the key parameters monitored were: Cl (depth of cervical lordosis); LI (depth of lumbar lordosis); the sagittal balance of Cl/Ll, and VThk (distance of the peak of the thoracic kyphosis from the ideal verticals-IV). A questionnaire was used to evaluate the level of movement activity in probands and the relation between the occurrence of painful back and headaches and the measurement of biomechanical parameters and movement activity. A total of 81.3 % of children and 94.5 % of adults were found to have deviations from the biomechanically ideal posture model, which signals a postural defect. The values of the Cl (p...

Bakgrund Ländryggssmärta är mycket vanligt förekommande i västvärlden. Det innebär stort lidande för individen och stora kostnader för samhället. Idag behandlas ryggsmärta med information om att vara aktiv och vid behov rådgivning om smärtstillande läkemedel. Mer kunskap behövs gällande fysisk träning som prevention och behandling av akut- och subakut ländryggssmärta. Syfte Syftet med studien var att, för patienter med akut- och subakut ländryggsmärta, beskriva den fysiska aktivitetsnivån samt eventuella skillnader i smärtintensitet och funktionsnedsättning mellan grupper med olika aktivitetsnivåer. Syftet var även att undersöka samband mellan aktivitetsnivå och smärtintensitet respektive aktivitetsnivå och funktionsnedsättning. Metod Studien var en enkätstudie med tvärsnittsdesign. Deltagarna var 15 patienter, 9 kvinnor och 6 män, medelålder 49,2 år, som sökt vård för akuta eller subakuta ländryggsbesvär till 4 olika primärvårdsenheter. Fysisk aktivitetsnivå skattades via Socialstyrelsens indikatorfrågor för fysisk aktivitet, smärtan med numerisk skattningsskala 0-10 (NRS) och Roland Morris Disability Questionnaire (RMDQ) besvarades. Data sammanställdes med deskriptiv statistik, skillnader testades med Mann-Whitney U-test och samband analyserades med Spearmans korrelationskoefficient. Resultat Åtta av 15 deltagare uppnådde Världshälsoorganisationens (WHO) rekommendationer för fysisk aktivitet (&gt; 150 minuter i veckan). De som ägnade sig åt fysisk träning minst 90 minuter per vecka hade medianvärde NRS 5,5 och RMDQ 8, för de som tränade mindre var motsvarande värden NRS 7,5 (p=0,153) och RMDQ 11,5 (p=0,175). Ett svagt negativt samband identifierades mellan NRS (r=-0,316,) och nivå av fysisk aktivitet medans sådant samband mellan RMDQ och fysisk aktivitetsnivå var negligerbart (r=-0,158). Slutsats Det var ingen statistiskt signifikant skillnad mellan grupperna som tränade minst 90 minuter per vecka och de som tränade mindre gällande varken smärtintensitet eller funktionsnedsättning. Ett svagt negativt men ej statistiskt signifikant samband kan ses mellan fysisk aktivitetsnivå och smärtintensitet. / Background Lower back pain is very common in the western world. It results in a great suffering for the person and large economic costs for the society. Today lower back pain is treated with information to stay active and medication for pain relief. There is a lack of knowledge with regards to what effect physical training has as prevention and treatment for acute and subacute lower back pain. Aim The aim of this study was to, among patients with acute and subacute non-specific lower back pain, describe their level of physical activity and evaluate differences between groups with different levels of activity. The aim was also to explore the association between pain intensity, disability and level of physical activity. Method The study was conducted as a survey. The participants was 15 patients, 6 men and 9 women with the mean age of 49,2 years old, who had sought care for acute and subacute lower back pain in 6 different primary care clinics. The level of physical activity were estimated using the indicator questions for physical activity by Socialstyrelsen, the pain intensity was measured with the Numeric Rating Scale and the Roland Morris Disability Questionnaire was answered. Data was analyzed with descriptive statistics, differences were tested with Mann-Whitney U-test and correlations analyzed with Spearman correlations coefficient. Results Eight out of 15 participants reached the WHO recommendations of physical activity (&gt; 150 min/week). Those who participated in physical training minimum 90 mins/week had a median value of NRS 5,5 and RMDQ 8. For those who trained less the median values were for NRS 7,5 (p=0,153) and RMDQ 11,5 (p=0,175). A week correlation between NRS (r=-0,136) and level of physical activity was noted while such correlation between RMDQ was negligible (r=-0,158). Conclusion There were no statically significant difference between the groups who trained at least 90 minutes per week and those who trained less neither in regards to pain intensity or disability. A weak but not statistically significant correlation was observed between physical activity and pain intensity.

Objetivo: avaliar os efeitos imediatos da manipulação de AVBA (alta velocidade e baixa amplitude) na sensibilidade dolorosa e nos parâmetros de avaliação do controle postural em participantes com dor lombar de origem inespecífica. Desenho do estudo: ensaio clínico randomizado, duplo cego (paciente e avaliador dos desfechos), com a presença de dois grupos, controle e intervenção. Contexto: a dor lombar é um problema crescente em vários países do mundo com a geração de altos custos em seu manuseio para os serviços de saúde. A implementação de técnicas de avaliação e tratamento são imperativos no entendimento e manejo dos sujeitos com dor lombar. A manipulação de AVBA lombar torna-se uma das formas de tratamento seguras e com baixo custo para a melhora da dor e da capacidade funcional de sujeitos com dor lombar de origem inespecífica. Método: 24 participantes, distribuídos em dois grupos, controle (recebeu manipulação simulada, apenas posicionamento) e intervenção (manipulação de AVBA lombar), 12 em cada grupo, de maneira aleatória, os quais preencheram os critérios da regra de predição clínica (dor inferior a 16 dias, dor que não passe do joelho, escore inferior a 19 no questionário de medos e crenças, rigidez vertebral e rotação interna de quadril maior que 35 graus, uni ou bilateralmente) para utilização da manipulação de AVBA. Foi utilizado a escala numérica de dor e a avaliação com algômetro (instrumento que avalia o limiar de pressão dolorosa) nos eretores da coluna lombar e no processo espinhoso (L1-L5 avaliado através do teste palpatório de pressão póstero-anterior), antes e depois da manipulação de AVBA lombar. Para avaliação das variáveis do controle postural, se fez uso da plataforma de força a qual mensurou a força de reação do solo, e partir desta utilizamos como variáveis a área da elipse, comprimento da trajetória e velocidade RMS para avaliação das alterações da posição do centro de pressão. Foram realizadas três repetições de cada estratégia do tornozelo (postura ereta semi estática) e do quadril (postura ereta semi estática em uma base de suporte menor nas direções ântero posterior) antes e após a manipulação simulada e manipulação de AVBA lombar. Resultados: obtivemos significância estatística na sensibilidade dolorosa, na escala numérica de dor, com diminuição da dor em ambos os grupos controle (p=0,01) e intervenção (p=0,02). Na avaliação com algômetro obtivemos significância estatística nos participantes alocados apenas para o grupo intervenção e na região do eretor esquerdo (p=0,04). Nas variáveis do controle postural, as quais foram avaliadas com ANOVA(s) de 4, 3 e 2 fatores, obtivemos diferenças significativas nos fatores principais estratégias e direção, com a estratégia do quadril tendo uma área e um comprimento de trajetória maior em comparação à estratégia do tornozelo, e a direção ântero-posterior apresentando um comprimento de trajetória maior, quando comparada à direção médio-lateral. Conclusão: Podemos estabelecer que os resultados e efeitos observados na escala numérica de dor e na algometria, foram atribuídos à resposta placebo da terapia manual e a modificação neurofisiológica provocada pela manipulação de AVBA na coluna lombar, respectivamente. Tornando desta forma, a técnica de manipulação uma ferramenta terapêutica para diminuição da dor nos pacientes com queixa lombar, respeitando as características de apresentação clínica e funcional de cada paciente para a aplicação da técnica de manipulação. Não foi possível demonstrar influência da manipulação lombar nos parâmetros posturais. / Aim: To assessment, the immediate effects of HVLA thrust manipulation (high velocity and low amplitude) in pain sensitivity and parameters of postural control in participants with nonspecific low back pain. Study design: Randomized clinical trial, double blind (patient and measurer of outcomes), with the presence of two groups, control and intervention. Background: low back pain is a growing problem in many countries of the world with the generation of high costs in handling for health services. The implementation of evaluation techniques and treatment are important to understanding management of subjects with nonspecific low back pain. Lumbar HVLA thrust manipulation becomes one of the safest forms of treatment and low costs to the improvement in pain and functionality of subjects with nonspecific low back pain. Methods: 24 participants are allocated randomly in two groups, control (which received sham manipulation) and intervention (lumbar HVLA thrust manipulation), 12 in each group, which met the criteria of clinical prediction rule (pain below than 16 days, pain that does not pass the knee, score less than 19 in the questionnaire fears and beliefs, spinal stiffness and internal rotation of the hip greater than 35 degrees, unilateral and bilateral). Was used the numerical pain scale and the algometer (instrument that assesses the pressure pain threshold) to assessment pain before and after delivery lumbar HVLA thrust manipulation. To evaluate the variables of postural control, if made use of the force platform, which measured the ground reaction force, and the variables of the postural control was area of the ellipse, the total length and RMS speed of the center of pressure displacement. Were performed three repetition for each ankle strategy (semi static upright posture) and hip (semi static upright posture in a lower supporting base) before and after delivery sham and lumbar HVLA thrust manipulation. Results: we obtained statistically significant in pain sensitivity on the rate scale of pain, with decreased in both groups control (p = 0.01) and intervention (p = 0.02). In the evaluation with algometer, we obtained statistically significant in participants allocated only for the intervention group and left erector region (p = 0.04). The variables of postural control, which were evaluated with ANOVA (s) 4, 3 and 2 factors showed significant differences in the major factors strategies and direction, the hip strategy having an area and a trajectory length larger than ankle strategy, and antero-posterior direction having a length trajectory larger than medial-lateral direction. Conclusion: We can establish that the results observed in the numerical pain scale and pressure pain threshold, were attributed to the placebo response of manual therapy and neurophysiological modifications caused by delivery HVLA manipulation in the lumbar spine, respectively. Moreover, the HVLA manipulation for lumbar spine is a therapeutic tool for decreasing pain in patients with back complaints respecting the functional characteristics and clinical presentation of the patient for the application of manipulation technique.

Title: Effect comparison of educational-movement therapy "stabilization function"of a trunk and traditional rehabilitation therapeutic approach for patients with nonspecific low back pain. Nonspecific low back pain is a main cause of disability and the principal cause for injury-related lost work-days. The various therapies for nonspecific low back pain have been elaborated in many studies. The recommended therapeutic guideline for primary care of patients with nonspecific low back pain is early mobilization combined with a specific rehabilitation therapeutic approach. One such specific rehabilitation therapeutic approach is "trunk stabilization" therapy. The objective of this dissertation is to compare a therapeutic approach involving "stabilization exercises" with the traditional clinical approach that has been clinically proven to be most efficacious for patients with acute nonspecific low back pain. This study compares the effects of the prescribed therapies on 24 patients with non- specific acute low back pain. The test subjects (men and women with an average age 41.2 years) were allocated into two simple randomized subgroups. The test subjects received 2 outpatient therapy sessions per week for 4 weeks. Pre-test and post-test spine shape and range of motion examination were determined using...

Orientador: Adriano Dias / Resumo: O objetivo desta pesquisa foi investigar a associação entre movimentação manual de pacientes e (1) a prevalência de distúrbios osteomusculares na região lombar e (2) a capacidade para o trabalho em profissionais da saúde, além de, (3) avaliar o grau de conhecimento desses profissionais sobre a movimentação manual de pacientes. Trata-se de um estudo transversal, cuja amostra foi composta por 320 profissionais de saúde que atuavam profissionalmente no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os resultados desta pesquisa foram três artigos científicos, apresentados neste manuscrito. O primeiro teve por objetivo investigar a prevalência de dor lombar e a associação desta com a movimentação manual de pacientes. A prevalência de período (três meses) de dor lombar foi de 57,8% (IC 95% 52,3%- 63,2%). A presença de dor lombar esteve significativamente associada com a movimentação manual de pacientes; de acordo com o modelo múltiplo de Poisson com variância robusta, a prevalência de dor lombar foi 44,4% maior (RP 1,444, IC 95% 1,169-1,783) entre os indivíduos que realizavam este tipo de atividade. O objetivo do segundo artigo foi avaliar a capacidade para o trabalho dos participantes e sua associação com a movimentação manual de pacientes. A pontuação média do Índice de Capacidade para o trabalho foi de 38,03 pontos (DP 6,15, IC 95% 37,33-38,72). A capacidade de trabalho inadequada (pontuação inferior a 37 pontos no Índice de Capacidade para o Trabalho) esteve signif... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The purpose of this research was to investigate the association between manual patient handling and (1) low back pain prevalence and (2) work ability among healthcare workers, and, also, (3) to examine their knowledge level of safe patient handling. This is a cross-sectional study. The sample consisted of 320 healthcare workers who worked at the University Hospital of Botucatu Medical School. The results of this research were three scientific papers, presented in this manuscript. The first one investigated low back pain prevalence and its association with manual patient handling. The 3-month period prevalence of low back pain was 57.8% (95% CI 52.3%- 63.2%). Low back pain was significantly associated with manual patient handling; according to the multiple Poisson regression model with robust variance low back pain prevalence was 44.4% higher (PR 1.444, 95% CI 1.169-1.783) among individuals who performed this activity. The second one evaluated the level of work ability and its association with manual patient handling. The Work Ability Index mean score was 38.03 points (SD 6.15, 95% CI 37.33-38.72). An inadequate level of work ability (Work Ability Index score lower than 37 points) was significantly associated with manual patient handling; according to the multiple Poisson regression model with robust variance inadequate level of work ability was 37.5% higher (PR 1.375, 95% CI 1.038-1.821) among individuals who performed this activity. Finally, the third one examined the knowle... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2016-06-02T20:19:04Z (GMT). No. of bitstreams: 1 DissRLC.pdf: 4124701 bytes, checksum: 7ad00279ff99c72a1e55ee44b80f553a (MD5) Previous issue date: 2007-02-02 / Financiadora de Estudos e Projetos / Despite recent technological advances, occupational activities of manual nature are still essential in many sectors and industries. Such activities impose risky conditions, which are inherent to its nature and can be responsible for musculoskeletal injuries. In addiction, the complexity and the interaction of risk factors, many still not comprehended, that act together during the performance of manual material handlings confer challenges and stimulations to the preventive approach. In this way, two main studies (Studies I and II) and two unfolding studies had been carried through. The main studies contextualized the hamstrings flexibility and its influence on the performance of occupational tasks. The objectives of Study I had been to compare the results of two clinical tests used to evaluate hamstrings flexibility and to evaluate the reliability of the photogrammetric procedure adopted for the analysis. The fingertip-to-floor test and straight leg raise test were applied in 35 healthy male subjects. Based on tests results, subjects were divided into two groups: normal and reduced flexibility. Superficial anatomical landmarks were fixed on bony references by means of manual palpation in order to permit the tracing of the hip, thoracic-lumbar, leg, knee and tibio-tarsal angles. The student t test was applied to evaluate the differences between the two groups, for each variable. Findings showed that hip angle was significant lower at the reduced flexibility group and that the straight leg raise test was more sensible for detecting subjects with reduced flexibility. The aim of Study II was to evaluate the influence of hamstrings flexibility on the movement strategy of the trunk and pelvis adopted by healthy subjects during the performance of the manual handling. Subjects were divided into two groups, based on the straight leg raise test. A JVC digital camera with a sampling of 50 frames/second and positioned perpendicularly to the sagittal plane of the subjects was used to register the activity. The cross-correlation coefficient was used to quantify movement patterns relationship between groups, and the student t test applied to the movement variables in order to determine differences between groups. The results had demonstrated that subjects with reduced flexibility used a lesser pelvic amplitude and bigger amplitudes of the trunk during handling. Still, subjects with reduced flexibility adopted a retroverted movement of the pelvis, without great alterations during the activity. The unfolding studies contextualized the comparison of the strategies adopted by subjects with experience in load handling activities and inexperienced individuals. The Study III had as objective to evaluate the manual handling performed by 16 experienced subjects and 15 inexperienced ones. It was used a flexible electrogoniometer to measure trunk movements and the University of Michigan 3D software to estimate the intradiscal compression in L5/S1 during the handling. The normalized movement patterns were evaluated and the coefficient of variation was applied to quantify the variability of this movement. The student t test determined the differences between variables. Results pointed out to great variability of adopted postures. Smaller amplitudes of flexion had been found, but bigger amplitudes of trunk extension when the loads were deposited, respectively, in low and high surfaces for experienced individuals. Experienced subjects presented lower intradiscal compression during box deposition and the lowering task was characterized by the highest intradiscal compression. Study IV aimed to compare manual handling strategies adopted by experienced and inexperienced subjects with relation to the positioning of the feet and trunk during lowering and inclination of the box during lowering and lifting activities. Ten experienced workers and 10 subjects without professional experience with the handling activity had been selected. The manual handling carried out between different heights was filmed. By means of one edition software, the images referring to the instant of 50% of the task had been selected and used to classify the postures and to measure the inclination of the box. An ANOVA with 3 factors was used to evaluate the inclination of the box with relation to the experience, handled load and type of handling (lifting and lowering). The results had indicated that subjects with professional experience adopted strategies characterized by biggest inclination of the box and adoption of balanced postures of the trunk, with widening of the support base. Professional experience determined the adoption of different movement strategies, when compared to inexperienced ones, in response to task conditions. However, other studies are suggested in order to determine if such strategies were protective or risky ones. The results presented in this dissertation raise the hypothesis that hamstrings flexibility is a risk factor for the increase of trunk overload, during the performance of manual material handling. / Apesar dos recentes avanços tecnológicos, as atividades ocupacionais de natureza manual ainda são imprescindíveis e amplamente utilizadas em muitos setores e indústrias. Tais atividades impõem condições de risco, que são inerentes à sua natureza e podem ser responsáveis por lesões músculo-esqueléticas. Em adição, a complexidade e a interação de fatores de risco, muitos ainda não totalmente compreendidos, que atuam em conjunto durante a realização do manuseio de materiais conferem desafios e estímulos à abordagem preventiva. Deste modo, foram realizados dois estudos principais e dois estudos decorrentes das pesquisas direcionadas ao estudo do manuseio de carga. Os estudos principais (Estudos I e II) contextualizam a flexibilidade dos músculos isquiotibiais e sua influência na performance de tarefas ocupacionais. Os objetivos do Estudo I foram comparar os resultados de dois testes clínicos utilizados para avaliar a flexibilidade dos músculos isquiotibiais e avaliar a confiabilidade do procedimento fotogramétrico utilizado. Os testes de Dedos ao Chão e Elevação dos Membros Inferiores (MMII) em Extensão foram aplicados em 35 sujeitos sadios do gênero masculino. Com base nos resultados dos testes, os sujeitos foram divididos em dois grupos: flexibilidade normal e reduzida. Marcadores superficiais refletivos foram fixados em referências ósseas por meio da palpação para permitir o traçado dos ângulos do quadril, tóraco-lombar, perna, joelho e tíbio-tarsico. Aplicou-se o teste t de student para avaliar as diferenças de cada variável entre os dois grupos. Os achados demonstraram que o ângulo do quadril foi significativamente menor no grupo com flexibilidade reduzida e o teste de Elevação dos MMII foi mais sensível para detectar sujeitos com redução de flexibilidade. O objetivo do Estudo II foi avaliar a influência da flexibilidade dos músculos isquiotibiais na estratégia de movimento do tronco e pelve adotada por sujeitos sadios durante a realização do manuseio de carga. Os sujeitos foram divididos em dois grupos, com base na aplicação do teste de Elevação dos MMII. Uma câmera digital JVC com amostragem de 50 quadros/segundo e posicionada perpendicularmente ao plano sagital dos sujeitos foi utilizada para registrar a atividade. O coeficiente de correlação cruzada foi utilizado para quantificar a relação dos padrões de movimento entre os grupos, e o teste t de student aplicado nas variáveis de movimento para determinar as diferenças entre grupos. Os resultados indicaram que sujeitos com flexibilidade reduzida utilizaram uma menor amplitude pélvica e uma maior amplitude do tronco durante o manuseio. Ainda, sujeitos com flexibilidade reduzida adotam movimento em retroversão da pelve, sem grandes alterações ao longo da atividade. Os desdobramentos (Estudos III e IV) contextualizaram a comparação das estratégias adotadas por sujeitos com experiência no manuseio de cargas e por indivíduos inexperientes em tais atividades. O Estudo III teve como objetivo avaliar o manuseio realizado por 16 sujeitos experientes e 15 inexperientes. Utilizou-se um eletrogoniômetro flexível para mensurar o movimento da coluna e o programa 3D da Universidade de Michigan para estimar a compressão intradiscal em L5/S1 durante o manuseio. Foram avaliados os padrões de movimento normalizados e o coeficiente de variação foi aplicado para quantificar a variabilidade deste movimento. O teste t de student foi aplicado na determinação das diferenças para as variáveis em estudo. Os resultados apontam para uma grande variabilidade de posturas adotadas. Foram encontradas menores amplitudes de flexão, mas maiores amplitudes de extensão da coluna quando as cargas eram depositadas, respectivamente, em superfícies baixas e altas para indivíduos experientes. Sujeitos experientes apresentaram menores valores de compressão intradiscal durante a deposição da caixa e a atividade de abaixamento com 15kg foi caracterizada por maior sobrecarga intradiscal. O Estudo IV teve como objetivos comparar as estratégias de manuseio realizadas por sujeitos experientes e inexperientes com relação ao posicionamento dos pés e tronco durante atividade de abaixamento e de inclinação da carga no levantamento e abaixamento. Foram selecionados 10 trabalhadores experientes e 10 sujeitos sem experiência profissional com o manuseio de cargas. O manuseio realizado entre diferentes alturas foi filmado. Por meio de um programa de edição, as imagens referentes ao instante de 50% da tarefa foram selecionadas e utilizadas para classificar as posturas e mensurar a inclinação da caixa. Utilizou-se uma ANOVA com 3 fatores para avaliar a inclinação da carga com relação à experiência, carga manuseada e tipo de manuseio (levantamento e abaixamento). Os resultados indicaram que sujeitos com experiência profissional do manuseio adotaram estratégias caracterizadas pela maior inclinação da caixa e adoção de posturas mais equilibradas do tronco, com afastamento dos pés. A experiência profissional parece determinar a adoção de estratégias de movimento diferentes do grupo inexperiente, em resposta às condições da atividade. Entretanto, novos estudos são sugeridos com o intuito de determinar se tais estratégias foram protetoras ou de risco. Ainda, o conjunto de resultados apresentados na dissertação levanta a hipótese de que a flexibilidade dos isquiotibiais seja um fator de risco para o aumento de sobrecarga na coluna, durante a realização do manuseio de materiais.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Chronic non-specific low back pain (CNSLBP) is a common ailment treated by chiropractors. Most chiropractors focus on the localised lumbar area of pain. Other chiropractors focus on restoring function to compensating articulations in the ‗full kinematic chain‘ by assessing and treating the lower extremity in conjunction to the low back. Patients with LBP often exhibit decreased hip-related ranges of motion that may result in future LBP, relapse and a prolonged recovery time. Studies investigating the effect of treating the kinematic chain in relation to LBP are limited and the literature, although widely taught and practiced, is largely anecdotal. Chiropractic manipulation has shown to be effective in the treatment of LBP and many lower extremity conditions. Objectives: This study set out to determine if a combination of low back and hip manipulation would result in a more beneficial outcome for the participant, suffering with CNSLBP, than low back manipulation alone in terms of objective and subjective outcomes. Method: The study was a randomised controlled clinical trial which, through purposive sampling, consisted of 50 participants with CNSLBP and hip joint dysfunction. The participants were randomly divided into two groups of 25 each [A and B]. Group A received low back manipulation alone and Group B received combined low back and hip manipulation. Subjective data was obtained through the Oswestry Low Back Pain Disability Index (ODI) and the Numerical Pain Rating Scale (NPRS). Objective data was obtained through the use of a Force Dial Algometer and an Inclinometer. Data collection occurred at the first, third and fifth consultations and was coded and analysed using IBM SPSS version 24.0. A p-value value of less than 0.05 was considered to be statistically relevant. Results: Intra-group testing showed that there was a significant difference over time, within both groups, with regards to internal rotation and external rotation of the hip, flexion of the lumbar spine, increased pain tolerance in Algometer tests, decreased NPRS values and decreased ODI scores. Within Group A, the mean scores for hip flexion reflected a more significant increase over time than those of Group B. Within Group B, the mean scores for left and right rotation of the lumbar spine reflected a more significant change over time than those of Group A. Inter-group testing showed no significantly differential treatment effect for any of the subjective and objective outcomes. This means that both treatments were equally effective and the hypothesis, that suggested that Group B would improve more than Group A, was incorrect. Conclusion: Both treatment groups improved subjectively and objectively with regards to CNSLBP. Inter-group testing showed that statistically, and for all outcome measurements, there were no significant differences between the two treatment group‘s results. This suggested that there was no additional benefit in combining hip joint manipulation with low back manipulation in the treatment of CNSLBP. / M

Introdução: Crenças de autoeficácia e de medo da dor e evitação do movimento influem na incapacidade em pacientes com lombalgia crônica e estratégia que as modifiquem são desejáveis. Objetivo: Analisar o efeito de um Programa de educação e exposição ao movimento (PROAME) na modificação dessas crenças, estilo de pensamento, humor e incapacidade em pacientes com lombalgia crônica. Método: Ensaio clínico randomizado, cegado para a avaliação do desfecho, realizado com 81 pacientes divididos em três grupos: Grupo A (três sessões de exposição e três sessões de educação), Grupo B (três sessões de educação) e Grupo C (controle). Foram elegíveis pacientes com lombalgia 6 meses,com pontuação na Escala Tampa de Cinesiofobia 51 pontos e na Escala de Autoeficácia para Dor Crônica 182 pontos. Os pontos de corte das crenças foram estabelecidos neste estudo. Autoeficácia e medo da dor e evitação do movimento foram desfechos primários. Pensamentos catastróficos, ansiedade, depressão, incapacidade e dor, desfechos secundários. A comparação dos desfechos entre os Grupos A, B e C foi feita por meio dos testes Qui-quadrado, Exato de Fisher, Equação de Estimação Generalizada, ANOVA e Kruskal Wallis. Resultado: Os pacientes dos Grupos A e B melhoraram a autoeficácia, o medo da dor e evitação do movimento, pensamentos catastróficos, ansiedade, depressão e incapacidade (p<0,001). Os doentes do Grupo C ficaram estáveis em todas essas variáveis. O Grupo A melhorou a intensidade dolorosa e características neuropáticas, quando comparado aos Grupos B e C (p<0,001). Na análise do Ciclo Vicioso do Medo da Dor e Evitação do Movimento, atividades do dia a dia (53,7%) e o movimento de curvar a coluna (48,2%) foram os que mais causavam dor. A dor com componente neuropático ocorreu em 39,2% dos relatos e em 71,4% das vezes havia pensamentos catastróficos. Medo exagerado estava presente em 44,4% dos que tinham incapacidade limitada e em 27,8% dos que apresentavam incapacidade maior. A hierarquização do medo no termômetro do prejuízo (escore de 0-100) mostrou que o medo acima de 50 pontos foi descrito em 24 de 40 atividades. .As atividades mais escolhidas para a exposição foram trabalhar com a pá (33,3%), correr (33,3%), carregar sacolas de compras uma em cada mão (25,9%), esfregar o chão com rodo (25,9%) e realizar abdominal no chão (25,9%). Houve redução dos escores de medo e ansiedade, após a primeira exposição (p<0,001) e segunda exposição (p<0,001). Conclusão: A parte educativa do PROAME foi capaz de melhorar as crenças disfuncionais, o humor e a incapacidade dos doentes, mas não a intensidade dolorosa. No entanto, somente a exposição ao movimento melhorou a intensidade da dor. A análise do Ciclo Vicioso mostrou a presença de medo exagerado ao movimento, catastrofização e incapacidade. / Introduction: Self-efficacy and fear of pain and avoidance of movement beliefs influence on disability in chronic low back pain patients and strategies for changing them are desirable. Objective: To analyze the effect of an educational and exposure to movement Program (PROAME) in modifying those beliefs, style of thinking, mood, and disability in chronic low back pain patients. Methods: Randomized clinical trial, blinded to outcome assessment, conducted with 81 patients divided into three groups: Group A (three exposure sessions and three educational sessions), group B (three education sessions) and Group C (control). Were eligible patients with low back pain 6 months with scores on Tampa Scale of kinesiophobia 51 points and Chronic Pain Self-efficacy Scale 182 points. Cutoff points of the beliefs were established in this study. Self-efficacy and fear of pain and avoidance of movement were primary outcomes. Catastrophic thoughts, anxiety, depression, disability and pain, secondary outcomes. The comparison of outcomes between groups A, B and C was made using the chi-square test, Fisher\'s exact, Generalized Estimation Equation, ANOVA and Kruskal Wallis. Results: Patients in Groups A and B improved self-efficacy, fear of pain and avoidance movement, catastrophic thoughts, anxiety, depression and disability (p <0.001). The Group C patients were stable in all these variables. Group A improved pain intensity and neuropathic characteristics when compared to Groups B and C (p <0.001). In Vicious Cycle of Fear of Pain and Avoidance of Movement analysis, daily activities (53.7%) and the movement of bending the spine (48.2%) were the ones that caused pain. The pain with a neuropathic component occurred in 39.2% of the reports and in 71.4% of cases had catastrophic thoughts. Exaggerated fear was present in 44.4% of those with limited disability, while 27.8% of those with greater disability. The fear hierarchy in thermometer harm (score 0-100) showed that fear above 50 has been reported in 24 of 40 activities. The activities most chosen for exposure were \"working with the shovel\" (33.3%), \"running\" (33.3%), \"carrying shopping bags - one in each hand\" (25.9%), \"mop the floor with squeegee\" (25.9%) and \"abdominal hold down\" (25.9%). There was a reduction of fear and anxiety scores after the first exposure (p <0.001) and second exposure (p <0.001). Conclusion: The educational part of PROAME was able to improve dysfunctional beliefs, mood and disability of patients, but not pain intensity. However, only the exposure to movement improved pain intensity. Analysis of the Vicious Cycle showed the presence of exaggerated fear of movement, catastrophizing and disability.

Pesquisadores de várias partes do mundo têm destacado os trabalhadores de enfermagem como um grupo de risco aos distúrbios osteomusculares, com destaque para a lombalgia como um dos fatores associados a prejuízos na execução da atividade laboral. Exercícios físicos são indicados nesses casos e dentre os indicados, destacam-se os baseados no método Pilates, por ativarem os mecanismos de controle neuromuscular e à sua efetividade no alívio da dor e melhora da função de indivíduos com lombalgia crônica não específica. A hipótese testada nesse estudo foi a de que os exercícios físicos baseados no método Pilates são mais efetivos no tratamento da lombalgia quando comparados aos exercícios convencionais de alongamento e fortalecimento. O objetivo da pesquisa foi comparar a efetividade de um protocolo de exercícios físicos baseado no método Pilates, considerando as variáveis dor lombar, flexibilidade de coluna cervical, tronco e quadril e força de glúteos, com outro protocolo contendo exercícios de alongamento e fortalecimento convencionais em profissionais da enfermagem com lombalgia crônica idiopática. Trata-se de um estudo de intervenção, controlado e não-randomizado com análise quantitativa dos dados do qual participaram 19 trabalhadores de enfermagem (enfermeiros, técnicos e auxiliares de enfermagem) de um hospital universitário do interior do estado de São Paulo. A coleta de dados foi realizada no período de setembro de 2009 a junho de 2010 por meio de aplicação de três instrumentos (pré-avaliação, formulário de dados pessoais e questionário Oswestry) e dois testes físicos (fleximetria e dinamometria). Os participantes foram divididos em dois grupos: um grupo controle (GC), o qual foi submetido ao protocolo de exercícios convencionais de alongamento e fortalecimento e o Grupo Pilates (GP), submetido ao protocolo de exercícios físicos baseado no método Pilates. Os dados foram analisados por meio dos softwares Statistical Package for the Social Science (SPSS), versão 15.0 for Windows e o statistical Analysis System (SAS), versão 9. Os exercícios físicos baseados no método Pilates obtiveram eficácia significativa na melhora da força de glúteo máximo direito e esquerdo (p < 0,01 e p = 0,04, respectivamente). Numa análise intra grupo, o GC apresentou uma melhora significativa da amplitude de tronco (Cs= 0,91 - p < 0,01) quando comparado ao GP após a intervenção. Com relação a dor lombar, ambos protocolos apresentaram melhora clínica. Verifica-se que o método Pilates de exercícios mostrou-se superiormente eficaz na melhora da força glútea quando comparado aos exercícios convencionais. Conclusão: O método Pilates apresenta aspectos incentivadores quando comparado aos programas de exercícios convencionais, além de peculiaridades, como número reduzido de repetições, trabalho do corpo como um todo e princípios que devem ser aplicados durante a execução do método, os quais determinam disciplina e consciência corporal. Tal fato pode proporcionar uma maior adesão nas atividades físicas ministradas para os trabalhadores de enfermagem em expedientes de trabalho. / Researchers from many countries have pointed nursing professionals as a risk group to osteomuscular disorders, with emphasis to lombalgy as one of the factors associated to impairment in the execution of laboral activities. Among the physical exercises indicated in these cases those based on the Pilates method stand out for the capability of activating neuromuscular control mechanisms, effectiveness to relieve pain and improvement of functioning of individuals with non-specific chronic low back pain. The hypothesis tested in the present study is that physical exercises based on the Pilates method are more effectivein the treatment of low back pain when compared to conventional stretching and strengthening exercises. The objetive of the present study was to compare the effectiveness of a physical exercises protocol based on the Pilates method, considering the variables low back pain, cervical spine, trunk and hips flexibility and gluteous strength, to another with conventional stretching and strengthening exercises in a group of nursing professionals with chronic idiopathic low back pain. It is a controlled non-randomized study with quantitative data analysis in which 19 nursing professionals participated (nurses, technicians and auxiliary nurses) from a university hospital in São Paulo state, Brazil. Data collection was conducted between September 2009 and June 2010 through application of three instruments (pre-assessment, personal data form and Oswestry questionnaire) and two physical tests (fleximetry and dynamometry). Participants were divided in two groups: a control group (CG), which was submitted to a conventional stretching and strengthening physical exercises protocol, and the Pilates Group (PG), submitted to the physical exercises protocol based on the Pilates method. Data was analyses through softwares Statistical Package for the Social Science (SPSS), version 15.0 for Windows and statistical Analysis System (SAS), version 9. Physical exercises based on the Pilates Method obtained significant efficacy in the improvement of strength of right and left gluteous maximus (p < 0,01 e p = 0,04, respectively). In an intragroup analysis, CG present a significant improvement of trunk amplitude (Cs= 0,91 - p < 0,01), when compared to PG after intervention. Concerning low back pain, both protocols presented clinical improvement. The Pilates method shows superior efficacy in the improvement of gluteous strength when compared to conventional exercises. Conclusion: The Pilates Method presents motivating aspects when compared to conventional exercises, besides particularities, such as number of repetitions, work the body as a whole and principles which sholud be applied during the execution of the method, which determine corporal discipline and consciousness. This could provide a greater adhesion to physical activities offered to nursing professionals during work time.