A Síndrome Dolorosa Femoropatelar (SDFP), possui etiologia multifatorial e acomete cerca de 7 a 15% da população, em sua maioria mulheres, jovens, adultas e ativas. Ela causa dor anterior ou retropatelar e é exacerbada durante gestos motores funcionais, tais como subir e descer escadas ou permanecer longos períodos de tempo sentado, agachado ou ajoelhado. Como a avaliação diagnóstica desta síndrome ainda é indireta, diversos mecanismos e metodologias buscam realizar uma classificação que diferencie os portadores de SDFP com relação aos assintomáticos. Deste modo, o objetivo desse trabalho é estudar as relações entre os sinais eletromiográficos (EMG) do músculo quadríceps em indivíduos com SDFP durante exercícios isométricos distintos (dissipativo e conservativo) em diferentes ângulos da articulação tíbiofemoral, e compará-los com os indivíduos sem SDFP. Foram analisadas a intensidade do sinal EMG (RMS), a frequência mediana (Fmed) e a frequência em 95% (F95) do espectro de potência dos músculos vasto medial oblíquo (VMO), vasto lateral (VL) e reto femoral (RF) para as contrações isométricas dissipativa e conservativa. Participaram deste estudo 24 voluntários do sexo feminino (17 assintomáticos e 7 com SDFP) que realizaram 18 contrações nos ângulos de 90º, 60º e 20º de extensão de joelho, utilizando 30% da carga voluntária máxima. Eletrodos EMG foram posicionados nos referidos músculos para a coleta dos dados, os quais foram posteriormente tratados e processados, possibilitando a análises do sinal EMG nos domínio do tempo e da frequência. Os resultados indicam que o RMS do sinal EMG apresenta-se distinto entre as contrações isométricas para o grupo sintomático e evidenciam que não existe uma relação de intensidade de contração EMG de um músculo comparativamente ao outro quando se altera o gesto motor. A Fmed de VMO e VL podem ser utilizadas como ferramenta na detecção de SDFP, visto que atuam de maneira distinta entre os grupos. A F95 do músculo VMO comporta-se de um modo diferente entre os grupos, sendo que durante a contração isométrica dissipativa em 20º e 60º, seus valores em SDFP foram maiores do que no grupo Controle. Desta maneira, foi possível relatar que é possível diferenciar a SDFP, ou até mesmo detectá-la, utilizando parâmetros EMG de padrões diferentes de contrações isométricas. / The Patellofemoral Pain Syndrome (PFPS) has a multifactorial etiology and affects approximately 7-15% of the population, mostly active young women. PFPS causes retropatellar pain, that is exacerbated during motor functional gestures, such as climbing stairs, sitting, squatting or kneeling for long periods of time. Since the diagnostic evaluation of this syndrome is still indirect, different mechanisms and methodologies seek to achieve a classification able to distinguish patients with PFPS from asymptomatic ones. Thus, the purpose of this study is to find the relationship between the electromyographic (EMG) signals of quadriceps in individuals with and without PFPS during isometric exercises (dissipative and conservative) at different angles of the tibiofemoral joint, to analyze the signal pattern of the control subjects and to compare with the SDFP group. We compared the root means square (RMS) of the EMG signal, median frequency (Fmed) and frequency in 95% of the power spectrum (F95) on the vastus medialis oblique (VMO), vastus lateralis (VL) and rectus femoris (RF) for dissipative and conservative contractions. 24 female volunteers participated in this study (17 asymptomatic patients and 7 with PFPS), who performed 18 contractions at angles of 90º, 60º and 20º of knee extension, using 30% of the maximal voluntary contraction. EMG electrodes were placed on those muscles for data collection, which were further processed using AqDAnalysis software for selection of traits, and MatLab® for processing and analysis of the signal in time and frequency domain. The results indicate that the RMS of EMG signal presents differences among the isometric contractions for the symptomatic group and show that there is a relationship of contraction of a muscle compared to the other when it changes the motor gesture. The Fmed of VMO and VL can be used as a tool in the detection of PFPS, because it acts differently in each group. The F95 of the VMO muscle behaves differently between groups, and during the dissipative isometric contraction at 20º and 60º, their values were higher in PFPS than in the control group. Thus, it was possible to report that it is possible to differentiate the PFPS, or even detect it using EMG parameters of different patterns of isometric contractions

Subir e descer escadas são atividades funcionais habituais e muito relatadas como queixa principal por pacientes com alterações ortopédicas como a síndrome dolorosa femoropatelar - por ser um movimento que acarreta descarga de peso unilateral e assim causa um aumento da dor - e por pacientes com afecções neurológicas - devido à dificuldade na execução deste gesto. Além disso, a subida e descida de escadas é habitualmente utilizada como técnica terapêutica na reabilitação destes pacientes; porém poucos estudos foram realizados com o intuito de caracterizar este gesto e, estes estudos, concluem que a alta variabilidade dos dados não permite confirmar os resultados. Estudos com pacientes com dor femoropatelar usualmente avaliam estes sujeitos com eletromiografia de superfície e sugerem que exista um déficit de equilíbrio na musculatura estabilizadora da patela e que esta é a causa da dor nestes pacientes; porém, também há uma grande variabilidade nos resultados encontrados, não sendo possível confirmar esta hipótese. Neste contexto, este estudo teve o objetivo de verificar quais parâmetros do sinal eletromiográfico apresentaram boa reprodutibilidade e menor variabilidade e são, portanto, mais adequados para caracterizar o gesto proposto, podendo ser utilizado para comparar grupos de indivíduos com e sem dor femoropatelar. Para isto, foi utilizada a eletromiografia para avaliar a atividade dos músculos vasto lateral e vasto medial do quadríceps durante a subida de escada em 39 indivíduos clinicamente saudáveis e 23 indivíduos com dor femoropatelar. Os resultados mostraram que os parâmetros que apresentaram boa reprodutibilidade entre os dois dias de avaliação foram: início de ativação, duração da contração muscular, tempo mediano da contração, intensidade do sinal, co-ativação muscular e frequência mediana. Dentre estes parâmetros, aqueles que permitiram diferenciar os grupos de estudo foram o tempo mediano da ativação, que ocorreu mais tardiamente nos indivíduos com dor e a co-ativação muscular, que demonstrou menor porcentagem de ativação conjunta nos indivíduos com dor. Estes dados indicam uma alteração no controle neuromotor durante a subida de escada, sugerindo que a abordagem clínica deva passar por treinos de equilíbrio, coordenação e propriocepção, para melhorar a estabilidade articular durante a realização de atividades dinâmicas. / Go up and down stairs are functional activities very habitual and reported as complaint for patients with orthopedic alterations as patellofemoral pain syndrome because it is a movement that carries unilateral weight bearing and thus cause an increase in pain and for patients with neurological disorders due to the difficulty in carrying out this gesture. Moreover, the ascent and descent of stairs is usually used as a therapeutic technique in the rehabilitation of these patients, but few studies have been conducted in order to characterize this gesture and, these studies conclude that the high variability of the data does not confirm the results. Studies on patients with patellofemoral pain usually assess these subjects with surface electromyography and suggest that there is a balance deficit in the patella stabilizer muscles and that this is the cause of pain in these patients, but there is also a great variability in the results, that does not allow to confirm this hypothesis. In this context, this study aimed to determine which parameters of electromyographic signals showed good reproducibility and low variability and are, therefore, more appropriate to characterize the proposed gesture and can be used to compare groups of individuals with and without patellofemoral pain. For this, we used electromyography to evaluate the activity of the vastus lateralis and vastus medialis of the quadriceps during stair climbing in 39 clinically healthy individuals and 23 individuals with patellofemoral pain. The results showed that the parameters with good reproducibility between the two days of evaluation were: onset, duration of muscle contraction, median time of contraction, intensity of activation, muscular co-activation and median frequency. Among these parameters, those that could differentiate the groups were the median time of activation, which occurred later in subjects with pain and muscle co-activation, which showed a lower percentage of combined activation in individuals with joint pain. These data indicate a change in neuromotor control during stair climbing, suggesting that the clinical approach should undergo training of balance, coordination and proprioception, in order to improve joint stability while performing dynamic activities.

The Gluteus Medius and the Tensor Fascia Lata are two of the main muscles involved in the action of hip abduction. This action is important for both dynamic movements in athletic pursuits and in every day ambulation. Weakness in these muscles has been connected to multiple injuries in the lower limb, but the question of the casual relationship between gait change, hip abductor weakness, and lower limb injury is still up for debate. As presented by the current research, younger populations tend to have overuse injuries with females having a greater susceptibility for injuries connected to hip abductor weakness, and older populations tend to have injures related to atrophy and degeneration of either the hip abductor muscles or the joint surrounding the hip. Research in this field has increasingly focused on sub-sets of the populations, such as just females or just males, trying to pinpoint the role that hip abductor weakness plays in these injuries. By trying to minimize or even eliminate the confounding variables that have previously made it difficult to determine the role hip abductor weakness plays in these gait changes and injuries, these studies have been able to make more clear conclusions at the expense of making a broader generalization. Similarities and differences between how the sub-groups present with hip abductor weakness are discussed, as well as discrepancies observed within the research done on similar cohorts. Future directions for research in this field are discussed, as well as implications for clinical implementation of targeted rehabilitation programs to ensure the best possible outcomes.

Diploma thesis "Patellofemoral pain syndrome and its affection by patellar taping" consists of two parts. The first general part summarises all present knowledge in the field of classification, diagnostics and therapy of this syndrome. The experimental part investigates a partial area of conservative therapy and a patellar taping technique according to McConnell. With the use of EMG records of a group of patients with patellofemoral pain syndrome it assesses the immediate effect of patellar taping on the pain intesity and timing of m. vastus medialis obliquus to m. vastus lateralis throughout three different movements. Powered by TCPDF (www.tcpdf.org)

Subir e descer escadas são atividades funcionais habituais e muito relatadas como queixa principal por pacientes com alterações ortopédicas como a síndrome dolorosa femoropatelar - por ser um movimento que acarreta descarga de peso unilateral e assim causa um aumento da dor - e por pacientes com afecções neurológicas - devido à dificuldade na execução deste gesto. Além disso, a subida e descida de escadas é habitualmente utilizada como técnica terapêutica na reabilitação destes pacientes; porém poucos estudos foram realizados com o intuito de caracterizar este gesto e, estes estudos, concluem que a alta variabilidade dos dados não permite confirmar os resultados. Estudos com pacientes com dor femoropatelar usualmente avaliam estes sujeitos com eletromiografia de superfície e sugerem que exista um déficit de equilíbrio na musculatura estabilizadora da patela e que esta é a causa da dor nestes pacientes; porém, também há uma grande variabilidade nos resultados encontrados, não sendo possível confirmar esta hipótese. Neste contexto, este estudo teve o objetivo de verificar quais parâmetros do sinal eletromiográfico apresentaram boa reprodutibilidade e menor variabilidade e são, portanto, mais adequados para caracterizar o gesto proposto, podendo ser utilizado para comparar grupos de indivíduos com e sem dor femoropatelar. Para isto, foi utilizada a eletromiografia para avaliar a atividade dos músculos vasto lateral e vasto medial do quadríceps durante a subida de escada em 39 indivíduos clinicamente saudáveis e 23 indivíduos com dor femoropatelar. Os resultados mostraram que os parâmetros que apresentaram boa reprodutibilidade entre os dois dias de avaliação foram: início de ativação, duração da contração muscular, tempo mediano da contração, intensidade do sinal, co-ativação muscular e frequência mediana. Dentre estes parâmetros, aqueles que permitiram diferenciar os grupos de estudo foram o tempo mediano da ativação, que ocorreu mais tardiamente nos indivíduos com dor e a co-ativação muscular, que demonstrou menor porcentagem de ativação conjunta nos indivíduos com dor. Estes dados indicam uma alteração no controle neuromotor durante a subida de escada, sugerindo que a abordagem clínica deva passar por treinos de equilíbrio, coordenação e propriocepção, para melhorar a estabilidade articular durante a realização de atividades dinâmicas. / Go up and down stairs are functional activities very habitual and reported as complaint for patients with orthopedic alterations as patellofemoral pain syndrome because it is a movement that carries unilateral weight bearing and thus cause an increase in pain and for patients with neurological disorders due to the difficulty in carrying out this gesture. Moreover, the ascent and descent of stairs is usually used as a therapeutic technique in the rehabilitation of these patients, but few studies have been conducted in order to characterize this gesture and, these studies conclude that the high variability of the data does not confirm the results. Studies on patients with patellofemoral pain usually assess these subjects with surface electromyography and suggest that there is a balance deficit in the patella stabilizer muscles and that this is the cause of pain in these patients, but there is also a great variability in the results, that does not allow to confirm this hypothesis. In this context, this study aimed to determine which parameters of electromyographic signals showed good reproducibility and low variability and are, therefore, more appropriate to characterize the proposed gesture and can be used to compare groups of individuals with and without patellofemoral pain. For this, we used electromyography to evaluate the activity of the vastus lateralis and vastus medialis of the quadriceps during stair climbing in 39 clinically healthy individuals and 23 individuals with patellofemoral pain. The results showed that the parameters with good reproducibility between the two days of evaluation were: onset, duration of muscle contraction, median time of contraction, intensity of activation, muscular co-activation and median frequency. Among these parameters, those that could differentiate the groups were the median time of activation, which occurred later in subjects with pain and muscle co-activation, which showed a lower percentage of combined activation in individuals with joint pain. These data indicate a change in neuromotor control during stair climbing, suggesting that the clinical approach should undergo training of balance, coordination and proprioception, in order to improve joint stability while performing dynamic activities.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-17T20:24:08Z No. of bitstreams: 1 Aline de Almeida Novello.pdf: 1138078 bytes, checksum: 601d6ef4a7fc406204ec932dce901793 (MD5) / Made available in DSpace on 2018-07-17T20:24:08Z (GMT). No. of bitstreams: 1 Aline de Almeida Novello.pdf: 1138078 bytes, checksum: 601d6ef4a7fc406204ec932dce901793 (MD5) Previous issue date: 2016-12-13 / Evidences found in the literature are inconsistent and there is no consensus about the kinematic differences performed by women with patellofemoral pain (PFP) during stair descent, and there are no studies that have evaluated the tridimensional kinematics of the trunk, pelvis, hip, knee and ankle using a multisegmental model of the foot, simultaneously during this task in patients with PFP and evaluated separately the sub phases of stair descent. Therefore, the aim of this study was to compare the tridimensional kinematics of the trunk, pelvis and lower limbs in different sub phases of stair descent and identify the discriminatory capability of the kinematic variables among PFP and healthy women during this task. In this cross-sectional study, thirty-four women with PFP (PFP group) and thirty-four painless women (control group) between 18 and 35 years-old underwent kinematic evaluation during the stair descent. It was observed that kinematic differences between groups occurred only in the first double support phase of the stair descent and the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact, the contralateral pelvic drop in the load-response, external rotation range of motion of the hindfoot in relation to the tibia and dorsiflexion of the forefoot in relation to the hindfoot were the variables that presented the best capacity to discriminate women with and without PFP. Therefore, our results provided a better understanding of the trunk, pelvis and lower limbs kinematics in different subphases of the support phase of stair descent in women with PFP. / As evidências encontradas na literatura são inconsistentes e não há consenso sobre as alterações cinemáticas em mulheres com dor femoropatelar (DFP) durante a descida de escadas. Além disso, não há estudos que tenham avaliado a cinemática tridimensional do tronco, pelve, quadril, joelho e tornozelo, utilizando um modelo multisegmentar do pé, simultaneamente durante esta tarefa em pacientes com DFP e que tenha avaliado separadamente as subfases da descida de escadas. Portanto, os objetivos deste estudo foram comparar a cinemática tridimensional do tronco, pelve, e membros inferiores em diferentes subfases da descida de escadas e identificar a capacidade discriminatória das variáveis cinemáticas entre mulheres com DFP e saudáveis nesta tarefa. Neste estudo transversal trinta e quatro mulheres com DFP (grupo DFP) e trinta e quatro mulheres sem dor (grupo controle) entre 18 e 35 anos foram submetidas à avaliação cinemática durante a descida de escadas. Foi observado que diferenças cinemáticas entre os grupos ocorreram somente na fase de primeiro duplo apoio da descida de escadas, sendo que as variáveis de rotação interna do retropé em relação à tíbia no contato inicial, a queda contralateral da pelve na resposta à carga, a amplitude de rotação externa do retropé em relação à tíbia e de dorsiflexão do antepé em relação ao retropé foram as variáveis que apresentaram melhor capacidade de discriminar mulheres com e sem DFP. Sendo assim, nossos resultados proporcionaram maior entendimento da cinemática do tronco, pelve e membros inferiores em diferentes subfases do apoio na descida de escadas em mulheres com DFP.

ABSTRACT Background: Patellofemoral pain syndrome (PFPS) is commonly seen in athletes and common symptoms are for example pain and stiffness, and difficulty in climbing stairs. Physiotherapy exercise interventions aim to increase the range of motion, strength, knee stability, balance, and functional ability. Shaping knowledge with patient education is a behaviour change technique that has proven important in musculoskeletal pain. How patient education can contribute to positive outcomes for physiotherapy exercise interventions in PFPS is unknown. Aim: To describe the effects of physiotherapy exercise interventions including patient education for adult and adolescent athletes with patellofemoral pain syndrome. Method: In a systematic literature review, only randomized controlled trials, on patients with a primary diagnosis of PFPS, published in English, were included. The data search was conducted by PICO in Pubmed and CINAHL. The methodological quality of the included studies was assessed by using the SBU checklist. Results: Six randomized controlled studies were included. According to the quality assessment the included studies had moderate to high quality and the outcome measures of the included studies were reliable and valid for measuring pain intensity, health-related quality of life, physical function, isometric muscle strength, and fear of movement. The results showed that physiotherapy interventions including patient education led to improved symptoms, functional ability, and health-related quality of life (HRQoL) for patients with patellofemoral pain syndrome in adult and adolescent athletes. Conclusion: Physiotherapy exercise interventions including patient education appear to increase physical function, muscle strength, and health-related quality of life and decrease pain and fear of movement for adult and adolescent athletes with patellofemoral pain syndrome. The conclusions are tentative as the review of the study quality for the included studies implied that four studies had a moderate risk of bias.

Sammanfattning Bakgrund: Patellofemoralt smärtsyndrom (PFSS) är ett vanligt förekommande muskuloskeletalt besvär bland kvinnor och karaktäriseras av smärta runt eller bakom patella, som förvärras vid vissa viktbärande aktiviteter. Då prevalens är hög hos kvinnor är det av stor betydelse att de får en välanpassad behandling baserad på den senaste tillgängliga evidensen. Syfte:  Att genom en litteraturstudie undersöka effekten av styrketräning på utfallsmåtten smärta och funktion hos kvinnor med PFSS samt gradera den aktuella evidensen. Metod: Litteratursökning utfördes i databasen PubMed. Nio artiklar inkluderades. Artiklarna granskades sedan enskilt enligt TESTEX scale och därefter bedömdes evidensgraden enligt SBU:s GRADE. Resultat: Studien visade en begränsad evidensgrad för att styrketräning av höftmuskulatur minskar smärta. Det finns även en begränsad evidensgrad för att kombinerad styrketräning av höft- och knämuskulatur minskar smärta och ökar funktion. Styrketräning av höftmuskulatur jämfört med styrketräning av endast knämuskulatur har ej effekt på funktion, men evidensgraden bedöms som begränsad. Studiekvaliteten av de enskilda studierna varierade mellan 7–13 poäng vid granskning med TESTEX scale. Konklusion: Evidensen talar för att kombinerad styrketräning av höft- och knämuskulatur bör användas i första hand vid behandling av PFSS, men fler studier behövs för att bekräfta studieresultatet.  Nyckelord: Exercise, hip musculature, patellofemoral pain syndrome, quadriceps musculature / Abstract Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition among women and is characterized by pain around or behind the patella, which is aggravated by weightbearing activities. Since the prevalence among women is high, it is of great importance that they receive a well-adjusted treatment based on the latest available evidence. Objective: To investigate through a literature study the effect of strength training on the outcome measures pain and function among women with PFPS Method: The litterature search was conducted in the database PubMed. Nine papers were included. The papers were evaluated by each author using the TESTEX scale and then the level of evidence was assessed according to SBU’s GRADE. Results: There is limited evidence that strength training of the hip musculature reduces pain. There is also limited evidence that combined strength training of the hip and knee musculature reduces pain and increases function. Compared to strength training of the knee musculature, isolated strength training of the hip musculature is no better to increase function but the evidence is limited. The study quality of the included papers varied between 7–13 points after evaluation with TESTEX scale. Conclusion: The evidence suggests that combined strength training of the hip and knee musculature should be used as the first line of treatment when treating PFPS, but further research is warranted. Key words: Exercise, hip musculature, patellofemoral pain syndrome, quadriceps musculature

Abstrakt Bakgrund: Patellofemoralt smärtsyndrom är ett vanligt förekommande smärttillstånd. Tejpning som behandlingsalternativ är väl använt av fysioterapeuter, trots bristande vetenskapligt underlag. Det skulle vara av värde att undersöka vad tidigare evidens säger kring tejpning som behandling vid PFSS.  Syfte: Att sammanställa och kartlägga om tejpning som isolerad eller kombinerad behandling minskar smärta hos personer med PFSS. Kvalitetsgranska resultaten av randomiserade kontrollstudier (RCT) med PEDro och bedöma dess tillförlitlighet med GRADEstud.  Metod: För systemisk litteratursökning formulerades följande PICO. P: Friska personer med PFSS, I: Tejpning, C: Annan behandling/ingen behandling, O: Smärtintensitet mätt med etablerade mätinstrument. Inklusionskriterier var randomiserade kontrollerade studier, studier publicerade de senaste 20 åren, studier på engelska och studier som finns att tillgå i fulltext.Exklusionskriterier var studier som är tillgängliga mot avgift. Systematisk sökning genomfördes i Pubmed, Cochrane och Web of Science. Åtta studier inkluderades och granskades med PEDro. GRADEstud användes för att bedöma resultatets tillförlitlighet.  Resultat: De åtta inkluderade studiernas kvalitet varierade mellan medelgod och hög kvalitet, enligt PEDro scale. Gällande kombinerad behandling fann två av de sex inkluderande studierna en signifkant skillnad. Gällande isolerad behandling fann en av de två studierna en signifikant skillnad. Det sammanvägda resultatets tillförlitlighet graderades som mycket låg (+), enligt GRADEstud.  Slutsats: Tejpning som behandling har en tvetydig evidens. Därmed kan denna studie inte avgöra huruvida tejpning har smärtlindrande effekt eller ej vid PFSS. / Abstract Background: Patellofemoral pain syndrome (PFPS) is a common pain condition. Taping as a treatment option is well used among physiotherapists, despite lack of evidence. It would be of value to investigate what earlier evidence says about taping as a treatment option in PFPS.  Objective: Compile and survey whether taping as an isolated or combined treatment has an effect on pain for people with PFPS. Quality review the results of randomized control studies (RCTs) with PEDro and assess its reliability with GRADEstud. Method: Structured question according to PICO. P: Healthy people with PFPS, I: Taping, C: Other / no treatment, O: Pain intensity measured with established measuring instruments. Inclusion criterias were RCTs, studies published in the last 20 years, studies in English and studies in full text. Exclusion criteria were studies available for a fee. Searches were conducted in Pubmed, Cochrane and Web of Science. Eight studies were included and reviewed with PEDro and GRADEstud.  Results: The eight included studies quality varied between moderate to high, according to the PEDro scale. Regarding combined treatment, two of the six included studies found a significant difference. Regarding isolated treatment only one of the two studies found a significant difference. The reliability of the weighted result was rated as very low (+), according to GRADEstud.  Conclusion: Taping as a treatment option has ambiguous evidence. Therefore, this study can not determine whether taping has a pain-relieving effect or not in PFPS.

No description available.