M.Tech.

Study Design: Single group pretest-posttest. Background: There is a lack of consensus concerning the preferred assessment and treatment for radial epicondylalgia. Objectives: Determine whether deficiencies in muscle force, joint range of motion, or painful force threshold are detected when measurements from the involved upper extremity are normalized to values from the uninvolved extremity. Methods and Measures: Ten patients (70% men) 42 ± 7 years in age with unilateral radial epicondylalgia participated. The visual analog pain scale and 6 measurements involving either muscle force, joint range of motion, or painful force threshold were examined. Results: When comparing the initial assessments to final assessments, a significant improvement was found for the visual analog pain scale (5 ± 3 vs 1 ± 3) and for the following normalized scores: grip (78 ± 26% vs 101 ± 20%) and isometric wrist extension forces (68 ± 24% vs 95 ± 35%), painful force threshold over the lateral epicondyle (49 ± 22% vs 94 ± 14%), and active wrist extension range of motion (83 ± 13% vs 96 ± 10%). Conclusions: Normalized force and range of motion measurements following treatment for unilateral radial epicondylalgia are sensitive assessments of patient progress. In comparison with measurements of force and range of motion that are not adjusted to a baseline score, normalized measurements detect changes in patient responses when baseline scores vary.

The modern game of tennis has changed in recent years as a result of lightweight, stiffer racquets. The evolution of the tennis racquet, with respect to both design and materials, has increased the speed of the game but also the levels of stress placed on the player's bodies. Many believe that injuries such as lateral epicondylitis (tennis elbow) are caused and aggravated by the absorption of racquet energy by the player, in the form of shock and vibration. This thesis presents an experimental investigation into the absorption of racquet vibration to the player's hand and forearm. Quantification of the tennis grip has been achieved in this research using different experimental techniques to analyse different aspects of the tennis grip. Grip pressure distribution profiles during impact have been established using both pressure sensitive film and real-time data acquisition methods. Quantification of grip tightness during impact, together with gripping times, has also been quantified using a strain gauge cantilever system manufactured specifically for this research. The experimental data acquired in this research has provided the base for grip pressure distribution profiles to be established for three stroke types (e.g. Forehand, service and the problematic backhand). The profiles depict the distribution of pressure in the tennis grip in relation to the ball impact, in the time domain. Based on these grip profiles, the research hypothesises hand movements in an attempt to establish muscle contractions (and moreover locations of vibration absorption) specific to stroke types. The research investigates the absorption of racquet vibrations by the player's hand in the time domain. Filtering of accelerometer data allows for the isolation of specific frequencies of interest (i.e. below 200Hz). Logarithmic decrement of racquet vibration has been calculated and related to the grip pressure distributions in the time domain, and the relationship between grip pressure and vibration damping has been modelled. The correlation between grip pressure and the logarithmic decrement has been show to be significant (p less than 0.005) and non-linear. The relationship between the tennis grip and the damping of racquet vibrations has been found to be dependant on both grip pressure and the proximity of grip pressure application in proximity to the handle node. Grip pressure applied to the racquet close to the handle node has a greater damping effect than a similar pressure further away. In addition to these key research findings, the effectiveness of a piezoelectric racquet damping system is also investigated. A comprehensive modal analysis of two tennis racquets is given with further ball impact tests. The ball impact tests showed that the damping system has a 28% difference in racquet vibrations during freely suspended grip conditions. However, under hand-held grip conditions the inclusion of grip damping into the system provides a much greater damping entity (880% greater). Therefore, the effect of the piezoelectric system was deemed to be negligible.

Title The objectification of using of kinesio taping to influence a muscle tone in epicondylitis. Objectives The aim of this master thesis is to find an effect of inhibitive kinesiotape application to muscle tone of hypertonic m. extensor digitorum communis and to pain of lateral epicondyl in lateral epicondylitis. Method The master thesis is divided to theoretical part and empirical research, which is based on the first part. The evaluation of m. extensor digitorum communis tension after kinesiotape application is provided by myotonometry method. The measurement is performed in 5 tested persons before and after two-day kinesio tape application. The questionaire Numeric pain rating scale helps to find a change of pain before and after kinesio tape application and then the dependence of pain to muscle tone change. Results The myotonometer measurement found a decrease of m. extensor digitorum communis tension for 4 from 5 tested persons after two-day application. The pain of lateral epicondyl was reduced for all probands. Keywords lateral epicondylitis, tennis elbow, muscle tone, kinesio taping, myotonometer

A repetitividade dos golpes em uma partida de tênis pode sobrecarregar a musculatura do punho e predispor a lesões, como a epicondilite lateral. A presente pesquisa propõe o uso de visão computacional para a obtenção de imagens tridimensionais reconstruídas, valores de forças atuantes em grupos musculares e articulações específicas e posições, velocidades e acelerações. O objetivo deste estudo é propor um método para descrever as características biomecânicas dos movimentos do punho durante a prática do tênis de campo, segundo as técnicas de punho rígido, a partir de parâmetros dinâmicos e cinemáticos, segundo variáveis físicas e antropométricas. Um indivíduo do sexo masculino, que possuí domínio das técnicas analisadas, realizou cinco sequências do movimento forehand em um laboratório de análise do movimento. Foi utilizado um sistema de aquisição de imagens (Qualisys Motion Capture Systems) que permitiu a reconstrução tridimensional dos movimentos dos segmentos. A partir de dados obtidos, através do sistema, verificou-se que os torques encontrados nos três eixos de movimento do punho, correspondentes aos movimentos de pronação, desvio ulnar e flexão de punho, apresentam magnitudes de 1.11 Nm, 3.98 Nm e 7.68 Nm, respectivamente. Verificou-se o maior valor de torque em torno do eixo z (flexão do punho), que será sustentado pela musculatura extensora de punho. A sobrecarga repetitiva dessa musculatura pode desencadear a epicondilite lateral. / The repeatability of the hitting in a tennis match can overload the muscles of the wrist and predispose to injury, such as lateral epicondylitis. This research proposes the use of computer vision for obtaining reconstructed three-dimensional images, active forces values in specific joints and muscle groups and positions, velocities and accelerations. The objective of this study is to propose a method to describe the biomechanical characteristics of the movements of the wrist during the practice of court tennis, using static wrist techniques, from kinematic and dynamic parameters, according to physical and anthropometric variables. A male person, who possess mastery of the techniques analyzed, held five forehand motion sequences in a laboratory analysis of the movement. It was used an image acquisition system (Qualisys Motion Capture Systems) that allowed the three-dimensional reconstruction of the movements of the segments. From the data obtained, through the system, it was found the torques in the three axes of motion of the wrist, corresponding to the movements of pronation, wrist flexion and ulnar deviation, which presented magnitudes of 1.11 Nm, 3.98 Nm and 7.68 Nm, respectively. It was found the greatest value of torque around the z axis (wrist flexion), which will be sustained by the extensor muscle of wrist. Repetitive overload of this muscle can unleash the epicondylitis.

A repetitividade dos golpes em uma partida de tênis pode sobrecarregar a musculatura do punho e predispor a lesões, como a epicondilite lateral. A presente pesquisa propõe o uso de visão computacional para a obtenção de imagens tridimensionais reconstruídas, valores de forças atuantes em grupos musculares e articulações específicas e posições, velocidades e acelerações. O objetivo deste estudo é propor um método para descrever as características biomecânicas dos movimentos do punho durante a prática do tênis de campo, segundo as técnicas de punho rígido, a partir de parâmetros dinâmicos e cinemáticos, segundo variáveis físicas e antropométricas. Um indivíduo do sexo masculino, que possuí domínio das técnicas analisadas, realizou cinco sequências do movimento forehand em um laboratório de análise do movimento. Foi utilizado um sistema de aquisição de imagens (Qualisys Motion Capture Systems) que permitiu a reconstrução tridimensional dos movimentos dos segmentos. A partir de dados obtidos, através do sistema, verificou-se que os torques encontrados nos três eixos de movimento do punho, correspondentes aos movimentos de pronação, desvio ulnar e flexão de punho, apresentam magnitudes de 1.11 Nm, 3.98 Nm e 7.68 Nm, respectivamente. Verificou-se o maior valor de torque em torno do eixo z (flexão do punho), que será sustentado pela musculatura extensora de punho. A sobrecarga repetitiva dessa musculatura pode desencadear a epicondilite lateral. / The repeatability of the hitting in a tennis match can overload the muscles of the wrist and predispose to injury, such as lateral epicondylitis. This research proposes the use of computer vision for obtaining reconstructed three-dimensional images, active forces values in specific joints and muscle groups and positions, velocities and accelerations. The objective of this study is to propose a method to describe the biomechanical characteristics of the movements of the wrist during the practice of court tennis, using static wrist techniques, from kinematic and dynamic parameters, according to physical and anthropometric variables. A male person, who possess mastery of the techniques analyzed, held five forehand motion sequences in a laboratory analysis of the movement. It was used an image acquisition system (Qualisys Motion Capture Systems) that allowed the three-dimensional reconstruction of the movements of the segments. From the data obtained, through the system, it was found the torques in the three axes of motion of the wrist, corresponding to the movements of pronation, wrist flexion and ulnar deviation, which presented magnitudes of 1.11 Nm, 3.98 Nm and 7.68 Nm, respectively. It was found the greatest value of torque around the z axis (wrist flexion), which will be sustained by the extensor muscle of wrist. Repetitive overload of this muscle can unleash the epicondylitis.

Les troubles musculo-squelettiques (TMS) sont la principale cause d’absentéisme au travail. Ils représentent un coût économique important, mais ils ont aussi de graves conséquences au niveau individuel – douleurs persistantes, limitations fonctionnelles ou perte d’emploi. De nombreuses expositions professionnelles ont déjà été mises en évidence pour expliquer la présence de ces symptômes, mais certaines relations restent encore à confirmer.L’objectif de ce travail de thèse était d’étudier l’association entre les facteurs professionnels, en particulier les facteurs physiques, et les TMS au niveau des coudes et des genoux. Les TMS au niveau des coudes ont été étudiés à travers la prévalence des symptômes aux coudes et des épicondylites, et l’incidence des épicondylites. Les douleurs aux genoux ont été étudiées à travers l’incidence des douleurs de courte ou de longue durée. Ce travail a nécessité l’utilisation de méthodologies spécifiques, en particulier les diagrammes causaux et les méthodes de gestion des données manquantes qui seront explicitées dans une partie théorique. La population dans ce travail de thèse était une cohorte de 3 710 sujets représentatifs des actifs des Pays de la Loire. Ils ont été recrutés entre 2002 et 2005 et ont été suivis entre 2007 et 2010. A chaque phase, un questionnaire sur les conditions de travail a été rempli par les participants et un examen clinique qui évaluait la présence de troubles musculo-squelettiques a été réalisé par des médecins du travail volontaires. En conclusion, les facteurs professionnels mis en évidence étaient globalement des facteurs de mouvements répétitifs impliquant les articulations étudiées (torsion des poignets et flexion/extension des coudes ou le fait de s’agenouiller). Le travail en force (manipulation de charges, efforts physiques importants) et les tâches répétitives ont également été mis en évidence comme prédicteurs de TMS ultérieurs / Musculoskeletal disorders (MSDs) are a leading cause of absenteeism from work. In addition to their major economic impact, musculoskeletal disorders have important consequences on individuals with the persistence of pain, disability and potential job loss. Many occupational exposures were highlighted to explain these symptoms, but certain relationships between occupational exposures and MSDs should be examined further.The aim of this thesis is to investigate the association between occupational exposures, especially biomechanical exposures, and elbow or knee MSDs. The elbow MSDs are studied with the prevalence of symptoms and lateral epicondylitis, and the incidence of lateral epicondylitis. The incidence of knee pain is examined according to its duration.The methodologies and theories appropriate to this type of work is briefly presented - a section focuses on the causal diagrams and methods of handling missing data.The population used is a cohort of 3710 subjects representative of the French workforce. Subjects were selected from workers undergoing a mandatory annual health examination between 2002 and 2005 and were followed between 2007 and 2010. For each phase of the study, a self-administered questionnaire on working conditions was completed and a clinical examination was performed in order to evaluate the presence of musculoskeletal disorders. In conclusion, repetitive movements involving the joints studied such as wrist-twisting, flexion/extension of the elbows or kneeling are associated with MSDs. The notion of force, such as load handling and physical exertion, and the notion of repetitive tasks are also identified as predictors of subsequent MSDs

The research obtained data on changes of status of the elbow joint under the influence of a complex of special physical exercises used in the warm-up. The results of the study are recommended for application in the work of the coaches with tennis players, with a diagnosis of lateral epicondylitis. / В диссертационном исследовании получены данные об изменении состояния локтевого сустава под влиянием комплекса специальных физических упражнений используемых в разминке. Результаты исследования рекомендованы для применения в работе тренеров с теннисистами, имеющими диагноз латеральный эпикондилит.

Syfte Syftet med föreliggande studie var att försöka klargöra om stötvågsbehandling har någon effekt på smärta och handgreppstyrka hos patienter med lateral epikondylalgia. Frågeställningar 1. Har stötvågsbehandling någon effekt på smärta hos patienter med lateral epikondylalgia, i så fall vilken? 2. Har stötvågsbehandling någon effekt på handgreppsstyrka hos patienter med lateral epikondylalgia, i så fall vilken? Metod Sökning av litteratur utfördes i PubMed, Cochrane, Cinahl och PEDro. Detta resulterade i 14 artiklar, som granskades och bedömdes enligt PEDro Scale. Poängbedömningen utifrån PEDro Scale omsattes till Statens Beredning för medicinsk Utrednings (SBU) mall för bevisvärde. Utifrån artiklarnas sammantagna bevisvärde bestämdes evidensnivån enligt SBU:s fyra nivåer. Resultat Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling har en smärtlindrande effekt vid lateral epikondylalgia. Studier av likartad vetenskaplig kvalitet påvisar motsägande resultat avseende om stötvågsbehandling är bättre än placebo, kortison eller tenotomi. Detta innebär att det vetenskapliga underlaget är otillräckligt och att mer forskning behövs. Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling leder till förbättrad handgreppsstyrka vid lateral epikondylalgia. Vidare förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling inte är bättre än någon annan behandling gällande ökning av handgreppsstyrka vid lateral epikondylalgia. Slutsats Stötvågsbehandling har en smärtlindrande effekt hos patienter med lateral epikondylalgia. Det finns dock ingen evidens för att stötvågsbehandling är bättre ur smärthänseende än någon annan behandling såsom placebo, kortison eller tenotomi. Stötvågsbehandling leder till förbättrad handgreppsstyrka men är inte bättre än placebo, kortison eller tenotomi på att öka handgreppsstyrkan hos patienter med lateral epikondylalgia. / Aim The aim of the present study was to try to find out whether shock wave therapy has any effect on pain and grip strength in patients with lateral epicondylitis. Objectives 1. Does shock wave therapy reduce pain in patients with lateral epicondylitis? 2. Does shock wave therapy improve grip strength in patients with lateral epicondylitis? Method A literature review was performed in the databases PubMed, Cochrane, Cinahl and PEDro. Fourteen articles were found and critically reviewed. These articles were scored according to the PEDro scale and the scores were translated into a scale of evidence by the Statens Beredning för medicinsk Utredning (SBU) and the level of evidence was determined based on the four different grades presented by the SBU. Results According to the GRADE-system there was a strong scientific evidence for a reduction of pain using shock wave therapy in patients with lateral epicondylitis. Contradictory results whether shock wave therapy was better than placebo, corticosteoroid injection or tenotomy have been reported in studies of similar scientific quality. This means that more research is needed in this field. According to the GRADE-system there was a strong scientific evidence for an improvement of grip strength using shock wave therapy. Furthermore, there was a strong scientific evidence for that shock wave is not better than any other therapy in terms of improving grip strength in patients with lateral epicondylitis. Conclusion Shock wave therapy reduces pain in patients with lateral epicondylitis. There is, however, no evidence for shock wave therapy to be superior to any other treatment such as placebo, corticosteoroid injection or tenotomy. Shock wave therapy improves grip strenght but is not better than placebo, corticoidsteroid injection or tenotomy in increasing grip strength in patients with lateral epicondylitis.