Tyrimo tikslas: pagrįsti priešsezoninių peties sąnario testavimų svarbą sportuojantiems pakeltomis rankomis. Tyrimo uždaviniai: 1. Nustatyti žasto vidinės ir išorinės rotacijų amplitudžių skirtumus tarp sportininkų su ankštumo sindromu ir be jo. 2. Nustatyti žasto vidinę ir išorinę rotacijas atliekančių raumenų jėgos skirtumus tarp sportininkų su ankštumo sindromu ir be jo. 3. Nustatyti pagrindinių mentę stabilizuojančių raumenų jėgos skirtumus tarp sportininkų su ankštumo sindromu ir be jo. 4. Nustatyti, ar gauti tyrimo rezultatai gali turėti įtakos sportininkų traumatizmui. Tyrimas buvo atliktas 2010 m. gegužės – spalio mėnesiais Lietuvos Kūno kultūros akademijoje „Žmogaus motorikos laboratorijoje“. Viso dalyvavo 65 tiriamieji iš kurių, pagal klinikinius testus kitiems tyrimams atrinkta 30 tiriamųjų. Sportininkai pagal gautus klinikinių testų rezultatus buvo suskirstyti į dvi grupes: kontrolinė – sveiki sportininkai (n═15) ir tiriamoji – su peties sąnario ankštumo sindromu (n═15). Tyrimo metodai: klinikiniai testai, žasto vidinės bei išorinės rotacijų amplitudžių nustatymas, trapecinio ir priekinio dantytojo raumenų manualinis testavimas, žasto išorinės ir vidinės rotacijų jėgos matavimas izokinetiniu dinamometru bei matematinė statistika. Išvados: 1. Nustatytas reikšmingas žasto išorinės ir vidinės rotacijų amplitudžių skirtumas tarp sportininkų su peties ankštumo sindromu ir be jo. 2. Nustatyta reikšmingai didesnė žasto vidinę ir išorinę rotacijas atliekančių... [toliau žr. visą tekstą] / Research Aim: To determine the importance of preseason shoulder testing for overhead athletes. Research Objectives: 1. Determine and evaluate shoulder external and internal rotation in overhead athletes with shoulder impingement syndrome and without. 2. Determine and evaluate the differences in bilateral isokinetic peak torque during shoulder internal and external rotation movements between overhead athletes with shoulder impingement syndrome and without. 3. Determine and evaluate the difference in strength of main scapular stabilizing muscles between overhead athletes with shoulder impingement syndrome and without. 4. Determine whether results of the research may affect the athletes' shoulder injuries. Research was conducted May-October 2010 in the ,,Human Motor Skills” laboratory at the Lithuanian Academy of Physical Sciences. 65 subjects took part in the research, and based on the results of clinical testing 30 subjects were chosen for comparison. Based on the clinical tests, 15 subjects showed no symptoms (‘control group’) while 15 showed symptoms of shoulder impingement (‘research group’). Research Methods: Clinical tests, shoulder internal and external ROM measurements, measured trapezius and serratus anterior muscle strength peak torque during shoulder internal and external rotation movements, and mathematical statistics. Conclusions: 1. Significant differences were determined in shoulder ROM between overhead athletes with impingement syndrome and those without... [to full text]

Falls in people aged over 65 years account for the largest proportion of all injury-related deaths and hospitalisations within Australia. Falls contributed to 1,000 deaths and 50,000 hospitalisations in older people during 1998 (Commonwealth Department of Health and Aged Care 2001). It has been predicted that by 2016, 16% of the Australian population will be aged over 65 years (Australian Bureau of Statistics 1999) placing considerable pressure on the health care system. Furthermore, prospective studies have shown that 30-50% of people aged 65 years and over, will experience a fall (Tinetti et al. 1988b; Campbell et al. 1989; Lord et al. 1994b; Hill 1999; Brauer et al. 2000; Stalenhoef et al. 2002) and this figure increases exponentially with age (Lord et al. 1994b). Many physiological falls risk factors have been established including reduced leg strength, poor balance, impaired vision, slowed reaction time and proprioception deficits. However, little research has been conducted to determine whether performance on aerobic fitness tasks is also a physiological falls risk factor. Aerobic fitness has previously been related to an individual's ability to perform activities of daily living, which in turn has been linked to falls. It was therefore proposed that aerobic fitness might also be a risk factor for falls among community dwelling older people. This research aimed to provide clinical evidence to inform public health practice. This thesis comprised of four objectives: the first to find suitable measures of aerobic fitness for older people; the second investigated relationships between existing clinical tests and future falls; the third explored relationships between aerobic fitness tests and future falls; the final objective was to examine the independent relationships between falls and clinical and physiological characteristics. The participants were recruited through a random sample from the local electoral roll, with an average age of 73 ±6 years. Of the 87 participants who completed the prospective component of the study, 37% were male and 63% were female. Sixty-three participants (65%) reported no previous falls, 19 (20%) reported a single fall, and 16 (15%) reported two or more falls in the previous 12 months. The first objective required participants recruited from the community to take part in submaximal and maximal fitness tests in order to find suitable measures of aerobic fitness. A further objective was to determine whether older people were able to fulfil the 'standard' criteria for completion of a maximum oxygen consumption test. The measures used in this research included: maximum oxygen consumption, peak oxygen consumption, ventilatory threshold, oxygen uptake kinetics, oxygen deficit, efficiencies, oxygen consumption at zero, 30 and 50 watts, predicted max and Six-Minute Walk Test distance. Only weak relationships were observed between submaximal aerobic measures and peak oxygen consumption. Furthermore, only 54% of participants were able to fulfil the criteria to complete a test of maximum oxygen consumption, indicating it was not a suitable measure for use among a sample of community dwelling older people. Therefore submaximal aerobic variables were used in the following chapters. The second objective investigated the relationship between clinical measures and falls among older people and was carried out to enable comparisons between the population in this study and those described in the literature. This research found that the Timed Up and Go (TUG) test was the most sensitive of all clinical tests (including the Berg Balance Scale, Function Reach, Performance Oriented Mobility Assessment and Physiological Profile Assessment) for the assessment of future falls. The TUG requires participants to stand up, walk 3m, turn, walk back, and sit down. Time taken to complete the test is the recorded value. For this study, a cut-off value of 7-seconds was established, above which individuals were at increased risk of falls. Previous research suggested cut-off times of over 10s were appropriate for older people. However, this is the first study to assess falls prospectively and definitively find that the TUG can discriminate between future fallers and non-fallers. This research also investigated the differences in falls risk factors for functionally different subsamples, as defined by their ability to undertake and complete the cycle test. The participants who could complete the test had significantly better balance ability and strength than those unable to undertake or complete the cycle test. However, this inability to undertake or complete the cycle test was not itself a predictor of future falls. These two groups also differed in the relationships between clinical test results and falls risk. Participants in the no-cycle group had very similar results to that of the entire cohort. Even after adjustment for age, the TUG, foot and hand reaction times and knee flexion strength were all performed better by non-fallers than fallers. However, none of these differed between fallers and non-fallers for participants in the cycle group. This group had better balance ability and strength than the no-cycle group. These results indicated that the cycle group differed from the no-cycle group and the entire sample, further indicating that factors other than the physiological variables measured in this research influence falls risk in strong participants with good balance ability. Similar results were reported when aerobic tests and falls were investigated in the third objective. In the whole sample, the fallers walked significantly less distance than non-fallers for the 6-MWT. Similar results were found for participants in the no-cycle group but not the cycle group. All participants were able to complete the Six-Minute Walk Test (6-MWT) although only 74% were able to undertake and complete the cycle test. The fourth objective was to consider all measures from the previous chapters as potential predictors of falls. The variables most predictive of future falls were the TUG and having experienced one or more falls in the previous 12 months. As a result they could be used as screening tools for the identification of high-risk fallers who require referral for further assessment. This could be completed by a General Practitioner or Practice Nurse, which would ensure that screening is being undertaken in the wider population. If the patient is at high risk they should be referred for falls risk factor assessment to determine an optimal tailored intervention to reduce future falls. Low risk patients should be referred for preventive evidence-based activities. These steps can potentially improve quality of life for individuals, and if effective in preventing future falls, will result in reduced costs to the individual and the Australian public. The results of this work demonstrate that the best screening tests are simple tasks like the TUG and asking an individual if they have experienced a fall in the last 12 months. This research also found that strong, mobile older people who could undertake and complete a submaximal cycle ergometer test, still experienced falls in the following 12 months, although the causes of this are currently unknown. This research showed that physiological falls risk factors are less relevant as these highly functional older people do not have physiological deficits. However, this research found that the 6-MWT showed promise as a predictor of falls in a group who could not complete a submaximal cycle ergometer test, who had lower strength, balance and functional fitness scores than a group who could complete this cycle test. The results showed that physiological falls risk factors are still very important for older people with lower physical abilities, and this is where aerobic fitness may still be related to falls. While the association between aerobic fitness and falls remains unclear, these are novel and provocative findings highlighting the need for future falls risk investigations to consider aerobic fitness as a contributing factor.

La compréhension de la biomécanique des structures articulaires est inhérente à l'amélioration de l'évaluation clinique de l'articulation coxo-fémorale. Cette articulation possède une capsule articulaire qui contient du liquide synovial et composée de ligaments capsulaires. Premièrement, le volume du liquide synovial peut être modifié en présence d'un problème articulaire. La pression intracapsulaire sera donc modifiée par ce changement de volume et par les mouvements articulaires effectués. Deuxièmement, les ligaments capsulaires s’allongent en fonction des différentes amplitudes articulaires. Les six degrés de liberté de mouvement de l'articulation coxo-fémorale rendent plus complexes l'évaluation et l'interprétation des pressions intracapsulaires et des allongements ligamentaires. À ce jour, les informations sur les pressions intracapsulaires et les allongements ligamentaires pendant les mouvements de l'articulation sont incomplètes ou limitées. La première étude visait à présenter les fluctuations des pressions intracapsulaires lors de cinq mouvements classiques au sein des compartiments capsulaire (latéral) et acétabulaire (médial). Latéralement, la pression est liée à l’amplitude articulaire. Médialement, la pression est beaucoup plus réactive aux mouvements. Cette première étude montre une variabilité importante entre les mouvements et les compartiments dans lesquels la pression est évaluée. La deuxième étude visait à rapporter les pressions dans les tests de provocation de flexion-abduction-rotation externe (FABER) et de flexion-adduction-rotation interne (FADIR). Lors du test de FABER, la pression intracapsulaire est négative dans les deux compartiments capsulaires. Pour le test de FADIR, la pression intracapsulaire est très élevée dans le compartiment latéral. Cette augmentation significative pourrait présenter une explication des problèmes de sensibilité et de spécificité du test de FADIR face à des modifications ostéologiques qui sont habituellement évaluées lors de son exécution. La troisième étude visait à présenter les allongements longitudinaux et transversaux du ligament iliofémoral lors de quatre mouvements articulaires soient l’abduction, la rotation externe et interne en extension et l’extension seule. Nos résultats montrent une hétérogénéité importante au sein des deux faisceaux du ligament iliofémoral lors de ces mouvements articulaires. La quatrième étude portait sur les allongements ligamentaires au sein du ligament iliofémoral lors du test de FABER. D’après nos résultats, il est possible d’observer des allongements significativement différents entre les faisceaux médial et latéral du ligament iliofémoral. Le faisceau latéral s’allonge dans sa globalité. L’allongement le plus important est observé dans la portion distale de ce faisceau. Médialement, le faisceau rétrécissait. Au regard de ces différents résultats entre les deux faisceaux, une distinction est nécessaire lors du test de FABER. En fait, ils auront des comportements complètement différents. En conclusion, ces quatre études portent sur l’analyse des pressions intracapsulaires et des allongements ligamentaires lors des mouvements classiques et des tests de provocation. Les différentes études montrent que la pression est dépendante du mouvement et du compartiment dans lequel elle est évaluée. Quant aux allongements, ceux-ci varient en regard du mouvement, de la portion et du faisceau dans lesquels ils sont évalués. Ces résultats soulignent l’importance de prendre en considération ces variations lors de l’évaluation clinique de la hanche. / Understanding tissue and joint biomechanics are inherent to improving the clinical evaluation of the coxofemoral joint. The coxofemoral joint has a joint capsule that contains synovial fluid and is composed of capsular ligaments. Firstly, the volume of synovial fluid can increase in the presence of a joint problem. The intra-articular pressure will therefore be modified by this change in volume and by the joint movements performed. Secondly, the capsular ligaments increase or decrease in length depending on the movement performed. The six degrees of freedom of movement of the coxofemoral joint make the assessment and interpretation of intra-articular pressures and ligament strains more complex. To date, information on intra-articular pressure and ligament strains during joint range of motion are incomplete or limited. The first study intended to present the fluctuations of intra-articular pressures during five classical movements within the capsular (lateral) and acetabular (medial) compartments. Laterally, the pressure is related to joint range of motion. Medially, the pressure is much more reactive. This study shows significant variability between movements and compartments in which the pressure is assessed. The second study aimed to report pressures in the flexion-abduction-external rotation (FABER) and flexion-adduction-internal rotation (FADIR) provocation tests. In the FABER test, the intra-articular pressure was negative in both capsular compartments. For the FADIR test, the intra-articular pressure was very high in the lateral compartment. This significant increase could present an explanation for the sensitivity and specificity problems of the FADIR test in the face of osteological changes. The third study aimed to present the longitudinal and transverse strains of the iliofemoral ligament during four joint movements, namely abduction, external and internal rotation in extension and extension alone. Our results show significant heterogenity within the two bands of the iliofemoral ligament during these joint movements. The fourth study looked at ligament strains within the iliofemoral ligament during the FABER test. According to our results, it is possible to observe significantly different strains between the medial and lateral bands of the iliofemoral ligament. The lateral band increase in length globally. The largest strain was observed in the distal portion of this band. Medially, the band decreases in length. In view of these different results between the two bands, it is important to distinguish them when performing the FABER test as they will have completely different behaviors. In conclusion, these four studies describe the analysis of intra-articular pressures and ligament strains during the classical movement and provocation test. They show that the pressure is dependent on the movement and the compartment in which it is assessed. As for ligament strains, they vary according to the movement, the portion, and the band in which they are evaluated. These results underline the importance of taking these variations into consideration during the clinical evaluation of the hip.

Title: The effect of physiotherapy on balance in multiple sclerosis Objectives: The aim of this study is to compare efficacy between ambulatory individual physiotherapy and complex inpatient rehabilitation in people with multiple sclerosis on balance and subjective evaluation of general health. In ambulant program to compare effect of different physiotherapeutic methods (Motoric program activating therapy, Manual physiotherapy correction, Reflex Locomotion according to Vojta). Methods: A combined design of study. Ambulant program has randomised assessor blind design, in which subjects were divided into one of the three groups of ambulatory physiotherapy. A clinical study without control arm design is used in case of comparison between complex and ambulatory program. Results were analysed in 45 patients with multiple sclerosis (25 subjects of ambulatory program, 20 subjects of complex program). Subjects of the ambulatory program were divided into one of the three groups of ambulatory physiotherapy (Motoric program activating therapy, Manual physiotherapy correction, Reflex Locomotion according to Vojta), in which they absolved during two months 20 therapies (2-3 times per week, length 60 minutes). Subjects of complex program underwent complex inpatient rehabilitation with duration about 21 days. The...