この論文は，筆頭著者の博士論文（膝蓋大腿関節痛を有する成人女性の膝蓋骨可動性についての研究（http://hdl.handle.net/2237/10676）の副論文として提出された。和文によるタイトル，抄録は博士論文提出の際に付けられた。

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

No description available.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 4 uppsatser.

Patellofemoral pain syndrome (PFPS) is the most common injury in runners and has a significant female sex bias. Current evidence suggests that several proximal factors, including hip muscle strength, hip muscle activation, and hip kinematics during running, play a large role in the development of PFPS, particularly in females. However, the relationships between these variables are unclear. A better understanding of these relationships in both males and females could help clinicians develop targeted interventions for this syndrome. Thus, this dissertation is comprised of four studies aimed to better understand the relationships between these risk factors. The first study investigated whether there are any relationships between hip muscle strength and hip muscle activation during running. Overall, hip muscle strength and hip muscle activity during running do not appear to be strongly related. The second study used a multiple regression approach to look for predictors of hip adduction and hip internal rotation during running. Sex was a significant predictor in both models, and running speed, static subtalar inversion range of motion, and gluteus maximus amplitude were significant predictors in the hip adduction model. The third study examined the effect of decreasing hip abduction strength on running kinematics and hip muscle EMG. After the fatigue protocol, there were no changes in gluteus medius amplitude or timing, and no changes in hip kinematics during running. However, there were some changes in kinematics, particularly at the trunk, as well as differences in gluteus maximus and tensor fascia latae activation. Finally, the fourth study used an alternative biomechanical method called continuous relative phase (CRP) to investigate the effect of sex and decreasing hip abduction strength on CRP variability at the hip. Decreasing hip abduction strength increased frontal plane CRP variability from 20-40% of stance phase, primarily in females, and females demonstrated less CRP variability than males in the frontal plane and transverse planes. Overall, the results from this study improve our understanding of the relationships between hip strength, hip muscle activation, and hip kinematics during running in both males and females, which may have implications for knee injury rehabilitation strategies. This dissertation includes unpublished co-authored material.

Orientador: Sergio Rocha Piedade / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T10:38:39Z (GMT). No. of bitstreams: 1 Reis_JuliaGuimaraes_M.pdf: 2248238 bytes, checksum: 945fbd990c61ac6b327c4c18556ee2e0 (MD5) Previous issue date: 2008 / Resumo: Das anormalidades que envolvem a articulação do joelho, a disfunção do aparelho extensor é um dos problemas mais freqüentemente encontrados na prática ortopédica. Para abranger toda a complexidade de investigação da locomoção necessita-se de informações qualitativa e quantitativa da cinética (momentos e forças) e cinemática (ângulos). O objetivo do estudo foi identificar e analisar as alterações biomecânicas dos indivíduos com instabilidade patelofemoral objetiva durante a marcha. A amostra foi composta de 10 indivíduos com instabilidade patelofemoral (grupoI), média de idade de 25,6 (±7,6) anos, média de altura de 1,63 (±0,06) m e média de peso de 63,3 (±13,52) kg; e, 14 indivíduos sem história de lesão músculo-esquelética (grupo controle ou grupo II), com média de idade de 24,14 (±2,71) anos, média de altura de 1,63 (±0,05) m e média de peso de 59,43 (±10,02) kg. Ambos os grupos foram submetidos a uma análise cinemática e cinética, onde os mesmos caminharam em velocidade livre, numa passarela de 10 m de comprimento. As imagens foram filmadas por seis câmeras do sistema Qualysis, que capturou os sinais de marcadores reflexíveis posicionados no membro inferior das voluntárias. Paralelamente, aplicou-se no grupo I uma avaliação clínica do grau de funcionalidade dos joelhos lesados, onde a pontuação os classificou como funcionalmente ruins; e, um exame físico, onde ambos os membros apresentaram-se estatisticamente semelhantes. A análise dos dados cinemáticos e cinéticos foi realizada pelo programa Qgait que mostrou menor flexão de joelho, nas fases de apoio e balanço (p<0,0001); menor momento extensor de joelho, no apoio (p<0,0001); e, maior força de reação do solo (p=0,4094), no grupo de pacientes em relação ao controle. Foram avaliados também parâmetros espaços-temporais como velocidade (p=0,0053), cadência (p=0,0376) e comprimento da passada (p=0,0021), onde o grupo I apresentou valores inferiores comparado ao grupo controle. Já no período de apoio (p=0,1186), o grupo I superou o grupo II. Estes resultados sugerem que o grupo I utilizou várias estratégias durante a marcha, na tentativa de reduzir a dor e a pressão na articulação patelofemoral. Entretanto, a força de reação do solo não foi reduzida, o que poderá resultar em danos a outras articulações, em longo prazo, devido a cargas repetitivas na articulação tíbiofemoral / Abstract: Abnormalities involving knee joint, the dysfunction of the extensor apparatus, it is one of the problems most often found in orthopaedic practice. To cover the full complexity of of locomotion research, it is necessary qualitative and quantitative information of kinetic (moments and forces) and kinematics (angles). The objective of the study was to identify and analyse the biomechanical changes of individuals with objective patellofemoral instability during gait. The sample was composed of 10 individuals with patellofemoral instability (group I), mean age of 25.6 (± 7.6) years, the average height of 1.63 (± 0.06) m and mean weight of 63.3 (± 13 , 52) kg; and 14 individuals with no history of musculo-skeletal injury (control group or group II), with an average age of 24.14 (± 2.71) years, the average height of 1.63 (± 0.05) m and mean weight of 59.43 (± 10.02) kg. Both groups were subjected to an analysis kinematics and kinetics, where they walked naturally on a 10 m walkway. The images were filmed by six cameras Qualysis system, which captured the signs of reflective markers placed on the lower limb of the volunteers. Paralely, was applied in the group I a functional clinical assessment of the degree functionality in the knee injured that classified it as bad functionally; and, physical examination, where both limbs showed up statistically similar. The analysis of kinematic and kinetic data was performed by the Qgait program that showed less of knee flexion, in the stance and balance phase (p <0.0001), less knee extensor moment, in support (p <0.0001); and, greatest ground reaction force (p = 0.4094) in the group of patients with respect to control. They were also assessed spatiotemporal parameters such as speed (p = 0.0053), cadence (p = 0.0376) and stride length (p = 0.0021), where the group I showed lower values compared to control group. Already in the support period (p = 0.1186), group I overcame the group II. These results suggest that the group I used several strategies during gait, in an attempt to reduce the pain and pressure in patellofemoral joint. However, the ground reaction force was not reduced, which could result in damage to other joints, in the long term, due to repetitive loads in tibiofemoral joint / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Orientador: Ricardo Machado Leite de Barros / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Física / Made available in DSpace on 2018-08-26T09:36:38Z (GMT). No. of bitstreams: 1 Sobral_JulianaMorenoCarmona_M.pdf: 1814656 bytes, checksum: 1821bbfffb02f428ed7b8b9ef7f46e78 (MD5) Previous issue date: 2014 / Resumo: O objetivo geral do trabalho foi propor e avaliar um método para análise cinemática tridimensional da articulação femoropatelar a partir de marcadores externos, durante a execução de saltos verticais. Para isso, foi desenvolvida uma configuração específica do sistema de análise, com seis câmeras industriais posicionadas de forma a garantir um bom valor de exatidão da medida gerada. A frequência de aquisição foi 100 Hz. O rastreamento dos segmentos corporais analisados e a reconstrução das respectivas coordenadas 3D foram realizados no software Dvideo. Já a orientação e modelagem foram feitas no software Visual 3D®. Neste estudo foram avaliados doze sujeitos saudáveis (grupo controle) e cinco sujeitos com síndrome femoropatelar em ambos os joelhos (grupo SFP). As variáveis analisadas foram a exatidão da medida do sistema, a distância entre os marcadores da patela, os ângulos de rotação do joelho e os ângulos de rotação e translação da articulação femoropatelar. A análise dos resultados foi feita após subdividir o movimento do salto em função do ângulo de flexão do joelho, em duas fases distintas, a decolagem (agachamento e impulsão) e a aterrissagem (aterrissagem e retorno à posição inicial). Os ângulos de rotação e valores de translação obtidos foram similares para os membros inferiores para as duas articulações analisadas. Já em relação às fases do movimento, todos os valores apresentaram menor magnitude na aterrissagem, uma vez que a amplitude de movimento de flexão do joelho nesta fase foi menor. Durante o agachamento, ambos os grupos apresentaram flexão, deslocamento medial, posterior e inferior da AFP, porém em menor amplitude no grupo SFP. A análise de confiabilidade apresentou valores de concordância excelente, sugerindo que o método utilizado gere dados consistentes. Podemos concluir que o modelo proposto foi capaz de detectar movimentação da patela em relação ao fêmur no eixo transversal para a rotação e nos eixos transversal, ântero-posterior e longitudinal para translação, em ambos os grupos estudados / Abstract: The major aim of this study was to propose and evaluate a method for three-dimensional kinematic analysis of the patellofemoral joint based on external markers while performing vertical jumps. For this, a specific configuration of the analysis system was developed, with six industrial cameras positioned to ensure a good accuracy of the measurement data. The acquisition frequency was 100 Hz. The analyzed body segments tracking and the reconstruction of their 3D coordinates were performed in Dvideo software. Their orientation and modeling were done in Visual 3D ® software. In this study we evaluated twelve healthy subjects (control group) and five subjects with patellofemoral syndrome in both knees (SFP group). The analyzed variables were the accuracy of the system, the distance between the markers of the patella, knee and patellofemoral rotation angles and translation values of the patellofemoral joint. The data analysis was made after subdividing the jump movement according to the angle of knee flexion in two distinct phases, takeoff (squat and propulsion) and landing (landing and return to starting position). The knee and patellofemoral obtained rotation angles and translation values were similar for both lower limbs. In relation to the vertical jump phases, all values were lower in the landing phase, due to the knee range of motion at this stage has been equally lower. During the squat, both groups showed flexion, medial, posterior and inferior displacement of the patellofemoral joint, but the SFP group showed smaller values. The reliability analysis showed excellent agreement values, suggesting that the method used in this study is capable to generate consistent data. We can conclude that the proposed model was able to detect patellar movement relative to the femur in the transverse axis for the rotation and in the transverse, anteroposterior and longitudinal axes for translation, in both groups / Mestrado / Biodinamica do Movimento e Esporte / Mestra em Educação Física

This thesis focused on the proximal factors associated with PFP, particularly, on hip muscle function. The overall purpose of this thesis was to elaborate a test, reliable and valid, for evaluating hip muscle function in females with PFP and that could be easily be used in the clinic. To reach this purpose, three sections have been considered:• Section 1 presented the results of a systematic review with meta-analysis entitled “Strength and endurance in females with patellofemoral pain”. This systematic review provided strong evidence that females with PFP have significant isometric strength deficit in hip abduction, extension, and external rotation when compared with healthy controls. Moderate evidence was obtained concerning isometric strength deficit in flexion. There was no evidence that females with PFP have strength deficits in adduction and internal rotation. Moderate evidence was found for isokinetic deficit in abduction and conflicting evidence for a deficit in rotation and extension. When compared with the uninjured limb, moderate evidence was found for a strength deficit in abduction, conflicting evidence for deficiencies in extension and external rotation strength and no evidence for internal rotation, adduction and flexion strength deficiencies. Finally, conflicting evidence was found for a decrease in hip muscular endurance.• Section 2 elaborated two clinical tests for the assessment of hip abductor endurance. After a preliminary phase, the hip abductor isometric endurance test was selected. The test-retest reliability and the validity were determined in healthy females and we concluded that the test could be recommended for clinicians.• Section 3 determined the applicability of the hip abductor isometric endurance test in females with PFP. We assessed the test-retest reliability of the hip abductor isometric endurance test in females with PFP and we compared holding time during the test between females with and without PFP. In this chapter, we chose also to use two others clinical tests, evaluating trunk extensor and ankle plantar flexor endurance, to compare females with and without PFP. We reported that females with PFP exhibited significantly lower hip abductor, trunk extensor and ankle plantar flexor endurance than healthy controls and we concluded that the hip abductor isometric endurance test could be recommended for the examination of patients with PFP. / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished

OBJECTIVE: Patellofemoral Pain Syndrome (PFPS) is the most common diagnosis in patients presenting knee pain (~25%), and one of the most common diagnosis in sports medicine centers. Here we examine believed risk factors in Patellofemoral Pain Syndrome (PFPS) and assess their relationship to PFPS. METHODS: The study was a retrospective study completed at Johns Hopkins Department of Orthopaedic Surgery. All patients, who were referred to physical therapy at Johns Hopkins Rehabilitation Therapy Services Clinic, were diagnosed with PFPS for the first time and were mostly recreational runners. Body mass indexes (BMI) were calculated from weight and height. Pain scores were taken using the visual analog scale. Strength measurements were taken from the left and right leg for the following measurements: hip abduction external rotation, hip abduction, knee extension, and hip extension. Balance measurements were also taken on the left and right sides measuring the postural sway with eyes open and eyes closed. Statistical analysis were accomplished using excel. RESULTS: A total of 23 patients were included in the present study, 9 females and 14 males. BMI's (lb/in^2) for the population was 25.1 (±4.2), males were 26.4 (±3.6) and females were 23.2 (±4.2). Pain scores were 6 (±1.9) out of 10 for the total population, males, and females. The total population had composite hip scores 35.0% and 22.9% for the right and left sides, while the knee extension was 50.7% and 51.7%. All hip scores were below 40 except for right hip ABD/ER in females and lower than knee extension scores in males, females, and total population. The ratio for right eyes closed to open was 34.2 (±62.7) and left eye closed to open was 24.7 (±44.3) for the total population CONCLUSION: This study demonstrated that age and BMI may have an effect on the development of PFPS but no statistical significance was confirmed. Results suggest that hip strength is a better indicator than knee strength in risk associated with PFPS. Balance appears to be more of an indicator of poor hip strength than as a measurement or potential risk factor for PFPS.