by Raymond Che Tin Li. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 149-168.

Thesis (M Sport Sc (Sport Science)--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Knee injuries are common among the physically active population and are often severe enough that it requires surgery. Rehabilitation specialists are on the constant look-out for the most efficient and cost-effective treatment alternatives to provide athletes with an early return to sport. The inclusion of backward locomotion in knee rehabilitation programs has been proposed since it is considered a safe closed kinetic chain exercise which has been found to increase quadriceps strength and power as well as cardiorespiratory fitness. The primary aim of the study was to establish the efficacy of backward locomotion training during a knee rehabilitation program. Thirty nine men and women (aged 18 to 59 years) with knee pathologies volunteered for the study and were randomly assigned to the experimental group (EXP, n = 20) and control group (CON, n = 19). All participants underwent a 24 session knee rehabilitation program which included 20 – 30 minutes of cardiorespiratory training, either in backward mode (EXP), or forward mode (CON). Aerobic fitness, quadriceps and hamstrings strength and power, single leg balance, lower limb circumferences, and lower limb flexibility were measured before and after the rehabilitation program. Backward locomotion training resulted in a borderline statistical significant improvement in ventilatory threshold (VT) (p = 0.07) and a statistical significant improvement in peak power output (PPO) (p < 0.05). The VT and PPO of the backward locomotion group increased by 9 and 14%, respectively, compared to 0 and 4% in the forward locomotion group. Both groups showed statistically significant improvements in quadriceps and hamstrings strength, except the quadriceps of the uninvolved leg of the forward locomotion group. Similarly, both groups showed a statistically significant improvement in quadriceps and hamstrings average power, except the quadriceps of the uninvolved leg of the forward locomotion group. Single leg balance of the involved and uninvolved legs improved statistically significantly in both groups (p < 0.05). The differences in change between the two interventions were not statistically significantly different (p > 0.05) and the practical differences were small (ES ± 0.2). No statistically significant differences in the change in leg circumferences were observed between the two groups. Only the change in flexibility of the involved soleus was significantly different between the EXP and CON groups. The results show that backward locomotion training result in greater improvements in aerobic fitness and equal or greater improvements in quadriceps and hamstrings muscle strength and power, compared to forward locomotion training. Backward locomotion as well as forward locomotion contributes to the recovery of knee injuries, however, the practical significance of backward locomotion is greater than for forward locomotion. The conclusion of this is that backward locomotion is a better alternative rehabilitation program for athletes as this will affect a quicker return to their sport. / AFRIKAANSE OPSOMMING: Kniebeserings kom algemeen voor in die fisiek aktiewe bevolking en is dikwels so ernstig dat dit chirurgie vereis. Rehabilitasie-spesialiste is voortdurend op soek na die mees doeltreffende en koste-effektiewe alternatief vir behandeling om die atlete vinnig te laat terugkeer na hul sport. Die insluiting van agteruitbeweging in knie-rehabilitasieprogramme is al in die verlede voorgestel, aangesien dit beskou word as 'n veilige geslote-kinetieseketting oefening wat al geskik bevind is om quadriceps sterkte en krag, asook kardiorespiratoriese fiksheid te verbeter. Die hoofdoel van die studie was om die effektiwiteit van agteruitbewegingoefening in 'n knierehabilitasieprogram te bepaal. Nege-en-dertig mans en vroue (tussen die ouderdom van 18 en 59 jaar) met kniepatologieë het vrywillig ingestem om aan die studie deel te neem en is lukraak verdeel in die eksperimentele groep (EXP, n = 20) en kontrole groep (CON, n = 19). Alle deelnemers het 24 sessies voltooi waarvan 20 – 30 minute kardiorespiratoriese oefeninge was. Dit het óf in die agteruitrigting (EXP), óf vorentoe-rigting (CON) plaasgevind. Aërobiese fiksheid, quadriceps en hamstrings sterkte en krag, eenbeenbalans, omtrekke van die onderste ledemaat, en soepelheid van die onderste ledemaat is gemeet, voor en na die rehabilitasieprogram. Agteruitbeweging-oefening het 'n geringe verbetering in ventilatoriese draaipunt (VT) (p = 0.07) opgelewer wat grens aan 'n statisties betekenisvolle verbetering, asook 'n statisties betekenisvolle verbetering in piek kraguitset (PPO) (p <0.05). Die VT en PPO van die agteruitbeweging groep het onderskeidelik verbeter met 9 en 14%, in vergelyking met 0 en 4% in die vorentoe-beweging groep. Beide groepe het statisties betekenisvolle verbeteringe in quadriceps en hamstrings sterkte getoon, behalwe die quadriceps van die onbeseerde been van die vorentoe-beweging groep. Soortgelyk daaraan het beide groepe statisties betekenisvolle verbeteringe in quadriceps en hamstrings gemiddelde krag getoon, behalwe die quadriceps van die onbeseerde been van die vorentoe-beweging groep. Eenbeenbalans van die beseerde en onbeseerde bene het statisties betekenisvol verbeter in beide groepe (p < 0.05). Die verskil in verandering tussen die twee intervensies was nie statisties betekenisvol verskillend nie en die praktiese verskil was klein (ES ± 0.2). Geen statisties betekenisvolle verskille is waargeneem tussen die twee groepe in die verandering in beenomtrekke nie. Slegs die soepelheid van die beseerde soleus van die EXP groep het statisties betekenisvol verbeter tussen die twee groepe. Die resultate toon dat agteruitbeweging-oefening tot groter verbetering gelei het in aërobiese fiksheid en gelyke of groter verbetering in quadriceps en hamstrings sterkte en krag, in vergelyking met vorentoe-beweging oefening. Agteruitbeweging-oefening sowel as vorentoe-beweging oefening dra by tot die herstel van kniebeserings, maar die praktiese beduidendheid van agteruitbeweging-oefening is groter as vorentoe-beweging oefening. Die gevolgtrekking van die studie is dat agteruitbeweging 'n beter alternatiewe rehabilitasieprogram vir atlete is, met 'n gevolglike vinniger terugkeer na hul sport.

Lam, Mak Ham. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 110-131). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

A síndrome fêmoro-patelar (SFP) acomete adultos jovens e caracteriza-se por dor no joelho durante a realização de atividades funcionais. Os fatores etiológicos incluem o aumento do ângulo Q e desequilíbrios musculares e para seu tratamento normalmente são realizados exercícios de fortalecimento do músculo quadríceps femoral, não sendo encontradas referências quanto ao uso de alongamento muscular no reequilíbrio da articulação fêmoro-patelar. Dessa forma, os objetivos deste estudo foram comparar a eficácia de exercícios de fortalecimento do músculo quadríceps femoral e alongamento dos músculos da cadeia posterior na recuperação funcional de pacientes com SFP. Para isso, foram selecionadas 40 mulheres sedentárias com idade entre 18 e 32 anos com SFP. Antes do tratamento foram avaliados: medida da flexibilidade, do encurtamento dos músculos isquiotibiais, do ângulo Q, aplicação de escalas da capacidade funcional (escala de contagem de Lysholm e escala de avaliação para a articulação fêmoro-patelar) e eletromiografia (EMG) dos músculos vasto medial (VM), vasto lateral (VL), bíceps femoral (BF) e gastrocnêmio porção lateral (GT) durante contrações isométricas de flexão e extensão da perna. Posteriormente, os pacientes foram divididos em quatro grupos de tratamento: o Grupo 1 (G1) realizou alongamento dos músculos da cadeia posterior pela técnica de reeducação postural global, o Grupo 2 (G2) realizou alongamento segmentar dos músculos isquiotibiais e gastrocnêmio, o Grupo 3 (G3) fortaleceu o músculo quadríceps femoral em cadeia cinética aberta e o Grupo 4 (G4) fortaleceu o mesmo músculo em cadeia cinética fechada, ambos com aumento progressivo da carga. Antes e após cada sessão de tratamento, as pacientes preenchiam a intensidade da dor no joelho numa escala visual analógica. O tratamento durou oito semanas com freqüência de duas vezes semanais. As variáveis obtidas antes e após o tratamento para cada grupo foram analisadas pelo teste de Wilcoxon e entre os grupos pela Anova e teste de Duncan ou Anova de Friedman ou Manova (&#945; < 0,05). Comparando as variáveis antes e após o tratamento, os resultados mostram que a intensidade da dor apresentou melhora significante no G1 e G3 e o ângulo Q diminuiu no G1 e G2. Para a atividade EMG, o músculo VM não sofreu alteração após o tratamento, o músculo VL aumentou no G2 e G3, o músculo BF aumentou apenas no G3 e o músculo GT aumentou no G3 e G4. Em todos os grupos, as escalas mostram melhora da capacidade funcional, diminuição do encurtamento dos músculos isquiotibiais e aumento da flexibilidade. Entre os grupos, o G1 tendeu a apresentar maior flexibilidade, o G4 maior atividade EMG do músculo BF, enquanto o G1 e G3 mostraram maior ativação do músculo GT. Os dados sugerem que os exercícios de alongamento muscular, em especial o global, também devem ser indicados no tratamento de pacientes com SFP, principalmente nas fases iniciais, onde se objetiva uma redução efetiva da intensidade da dor. Além disso, também possibilitou maior realinhamento do joelho (redução do ângulo Q) e aumento da flexibilidade, o que pode facilitar o fortalecimento muscular. / The patellofemoral syndrome (PFS) affects young adults and is characterized by knee pain during functional activities. PFS etiology includes bigger Q angle and muscular imbalances. For treatment, quadriceps femoris strengthening are normally performed, but we were unable to locate documentation about the application of stretching exercises in the patellofemoral joint rehabilitation. The aim of this study was to compare the efficacy of quadriceps femoris muscle strengthening and posterior chain stretching exercises in the functional recovery of PFS patients. Forty female nonathletes aged between 18 and 32 years old were recruited. Before treatment, it was measured: flexibility, hamstring tightness, Q angle, functional injury level of the knee by the application of questionnaires and electromyography (EMG) of the vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF) and lateral gastrocnemius(LG) muscles during isometric contractions of leg flexion and extension. After this initial evaluation, patients were divided into four treatment groups: Group 1 (G1) performed posterior chain global stretching exercises, Group 2 (G2) segmentary stretching exercises of hamstring and gastrocnemius muscles, Group 3 (G3) quadriceps femoris strengthening exercises in open kinetic chain and Group 4 (G4) quadriceps femoris strengthening exercises in closed kinetic chain, with progressively resistance increases. This treatment lasted eight weeks, twice a week. Before and after each treatment session, the visual analogue scale accessed pain intensity. The data obtained before and after treatment for all groups were analyzed by Wilcoxon test, and the data between groups by Anova and Duncan test or Friedman Anova or Manova (&#945; < 0.05). Comparing the data before and after treatment, the results showed a significant improvement in pain intensity in G1 and G3 and a decreased Q angle in G1 and G2. For the EMG activity, VM muscle activity was not modified after treatment, VL activity increased in G2 and G3, BF activity increased only in G3 and LG activity increased in G3 and G4. Between groups, G1 showed greatest flexibility, G4 greatest EMG activity of BF muscle, while G1 and G3 showed greatest activity of LG muscle. Based on these results, we suggest that stretching exercises, specifically in global modality, can be prescribed in PFS treatment, especially in its initial phases, for an effective reduction of pain intensity. Moreover, this treatment caused a knee alignment (by reducing Q angle)and flexibility improvement, which may facilitate muscular strengthening.

A síndrome fêmoro-patelar (SFP) acomete adultos jovens e caracteriza-se por dor no joelho durante a realização de atividades funcionais. Os fatores etiológicos incluem o aumento do ângulo Q e desequilíbrios musculares e para seu tratamento normalmente são realizados exercícios de fortalecimento do músculo quadríceps femoral, não sendo encontradas referências quanto ao uso de alongamento muscular no reequilíbrio da articulação fêmoro-patelar. Dessa forma, os objetivos deste estudo foram comparar a eficácia de exercícios de fortalecimento do músculo quadríceps femoral e alongamento dos músculos da cadeia posterior na recuperação funcional de pacientes com SFP. Para isso, foram selecionadas 40 mulheres sedentárias com idade entre 18 e 32 anos com SFP. Antes do tratamento foram avaliados: medida da flexibilidade, do encurtamento dos músculos isquiotibiais, do ângulo Q, aplicação de escalas da capacidade funcional (escala de contagem de Lysholm e escala de avaliação para a articulação fêmoro-patelar) e eletromiografia (EMG) dos músculos vasto medial (VM), vasto lateral (VL), bíceps femoral (BF) e gastrocnêmio porção lateral (GT) durante contrações isométricas de flexão e extensão da perna. Posteriormente, os pacientes foram divididos em quatro grupos de tratamento: o Grupo 1 (G1) realizou alongamento dos músculos da cadeia posterior pela técnica de reeducação postural global, o Grupo 2 (G2) realizou alongamento segmentar dos músculos isquiotibiais e gastrocnêmio, o Grupo 3 (G3) fortaleceu o músculo quadríceps femoral em cadeia cinética aberta e o Grupo 4 (G4) fortaleceu o mesmo músculo em cadeia cinética fechada, ambos com aumento progressivo da carga. Antes e após cada sessão de tratamento, as pacientes preenchiam a intensidade da dor no joelho numa escala visual analógica. O tratamento durou oito semanas com freqüência de duas vezes semanais. As variáveis obtidas antes e após o tratamento para cada grupo foram analisadas pelo teste de Wilcoxon e entre os grupos pela Anova e teste de Duncan ou Anova de Friedman ou Manova (&#945; < 0,05). Comparando as variáveis antes e após o tratamento, os resultados mostram que a intensidade da dor apresentou melhora significante no G1 e G3 e o ângulo Q diminuiu no G1 e G2. Para a atividade EMG, o músculo VM não sofreu alteração após o tratamento, o músculo VL aumentou no G2 e G3, o músculo BF aumentou apenas no G3 e o músculo GT aumentou no G3 e G4. Em todos os grupos, as escalas mostram melhora da capacidade funcional, diminuição do encurtamento dos músculos isquiotibiais e aumento da flexibilidade. Entre os grupos, o G1 tendeu a apresentar maior flexibilidade, o G4 maior atividade EMG do músculo BF, enquanto o G1 e G3 mostraram maior ativação do músculo GT. Os dados sugerem que os exercícios de alongamento muscular, em especial o global, também devem ser indicados no tratamento de pacientes com SFP, principalmente nas fases iniciais, onde se objetiva uma redução efetiva da intensidade da dor. Além disso, também possibilitou maior realinhamento do joelho (redução do ângulo Q) e aumento da flexibilidade, o que pode facilitar o fortalecimento muscular. / The patellofemoral syndrome (PFS) affects young adults and is characterized by knee pain during functional activities. PFS etiology includes bigger Q angle and muscular imbalances. For treatment, quadriceps femoris strengthening are normally performed, but we were unable to locate documentation about the application of stretching exercises in the patellofemoral joint rehabilitation. The aim of this study was to compare the efficacy of quadriceps femoris muscle strengthening and posterior chain stretching exercises in the functional recovery of PFS patients. Forty female nonathletes aged between 18 and 32 years old were recruited. Before treatment, it was measured: flexibility, hamstring tightness, Q angle, functional injury level of the knee by the application of questionnaires and electromyography (EMG) of the vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF) and lateral gastrocnemius(LG) muscles during isometric contractions of leg flexion and extension. After this initial evaluation, patients were divided into four treatment groups: Group 1 (G1) performed posterior chain global stretching exercises, Group 2 (G2) segmentary stretching exercises of hamstring and gastrocnemius muscles, Group 3 (G3) quadriceps femoris strengthening exercises in open kinetic chain and Group 4 (G4) quadriceps femoris strengthening exercises in closed kinetic chain, with progressively resistance increases. This treatment lasted eight weeks, twice a week. Before and after each treatment session, the visual analogue scale accessed pain intensity. The data obtained before and after treatment for all groups were analyzed by Wilcoxon test, and the data between groups by Anova and Duncan test or Friedman Anova or Manova (&#945; < 0.05). Comparing the data before and after treatment, the results showed a significant improvement in pain intensity in G1 and G3 and a decreased Q angle in G1 and G2. For the EMG activity, VM muscle activity was not modified after treatment, VL activity increased in G2 and G3, BF activity increased only in G3 and LG activity increased in G3 and G4. Between groups, G1 showed greatest flexibility, G4 greatest EMG activity of BF muscle, while G1 and G3 showed greatest activity of LG muscle. Based on these results, we suggest that stretching exercises, specifically in global modality, can be prescribed in PFS treatment, especially in its initial phases, for an effective reduction of pain intensity. Moreover, this treatment caused a knee alignment (by reducing Q angle)and flexibility improvement, which may facilitate muscular strengthening.