Stretching is a widely prescribed technique that has been demonstrated to increase range of motion. Consequently it may enhance performance and aid in the prevention and treatment of injury. Few studies have investigated the frequency of stretching on a daily basis. The purpose of this study was to investigate the effect of stretching frequency on range of motion at the ankle joint. The detraining effect was also investigated after a period without stretching. Thirty-one female subjects participated in this study. They were randomly assigned to a control group who did not stretch a group who stretched two times per week (Stretch-2) or a group who stretched four times per week (Stretch-4). The stretching intervention was undertaken over four weeks and targeted the gastrocnemius and soleus muscles. Each stretch was held for duration of 30 seconds and repeated five times. Prior to the intervention (PRE), dorsiflexion was measured using a weights and pulley system that passively moved the ankle joint from a neutral position into dorsiflexion. After the four week stretching period (POST), dorsiflexion was measured once again to determine the change following the stretching programme. Following a further four week period where no stretching took place (FINAL), dorsiflexion was measured to determine the detraining effect. Electromyography was used to monitor the activity of the plantarflexors and dorsiflexors during the measuring procedure. The results of the study showed a significant increase in ankle joint range of motion for the Stretch-4 group (p<0.05) when comparing PRE and POST measurements. The Stretch-2 and control groups did not show significant differences (p>0.05) between PRE and POST measurements. When comparing the PRE and FINAL measurements of the Stretch-4 group, no significant differences were recorded (p>0.05). The POST and FINAL measurements were significantly different (p<0.05). After the detraining period the Stretch-4 group lost 99.8% of their range of motion gains. The present data provide some evidence that the viscoelastic properties of the muscle stretched were unchanged by the four week static stretching programme. The mechanism involved in the observed increase in range of motion for the Stretch-4 group is possibly that of enhanced stretch tolerance of the subject. Further research is required to support this conjecture.

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Stretching is a widely prescribed technique that has been demonstrated to increase range of motion. Consequently it may enhance performance and aid in the prevention and treatment of injury. Few studies have investigated the frequency of stretching on a daily basis. The purpose of this study was to investigate the effect of stretching frequency on range of motion at the ankle joint. The detraining effect was also investigated after a period without stretching. Thirty-one female subjects participated in this study. They were randomly assigned to a control group who did not stretch a group who stretched two times per week (Stretch-2) or a group who stretched four times per week (Stretch-4). The stretching intervention was undertaken over four weeks and targeted the gastrocnemius and soleus muscles. Each stretch was held for duration of 30 seconds and repeated five times. Prior to the intervention (PRE), dorsiflexion was measured using a weights and pulley system that passively moved the ankle joint from a neutral position into dorsiflexion. After the four week stretching period (POST), dorsiflexion was measured once again to determine the change following the stretching programme. Following a further four week period where no stretching took place (FINAL), dorsiflexion was measured to determine the detraining effect. Electromyography was used to monitor the activity of the plantarflexors and dorsiflexors during the measuring procedure. The results of the study showed a significant increase in ankle joint range of motion for the Stretch-4 group (p<0.05) when comparing PRE and POST measurements. The Stretch-2 and control groups did not show significant differences (p>0.05) between PRE and POST measurements. When comparing the PRE and FINAL measurements of the Stretch-4 group, no significant differences were recorded (p>0.05). The POST and FINAL measurements were significantly different (p<0.05). After the detraining period the Stretch-4 group lost 99.8% of their range of motion gains. The present data provide some evidence that the viscoelastic properties of the muscle stretched were unchanged by the four week static stretching programme. The mechanism involved in the observed increase in range of motion for the Stretch-4 group is possibly that of enhanced stretch tolerance of the subject. Further research is required to support this conjecture.

Ankle sprains are one of the most common musculoskeletal injuries. Physiotherapy treatment and advice to rest, use ice, use compression, and elevate the ankle (RICE advice) is believed to speed up the functional recovery and enhance healing associated with acute ankle sprains. However, there is limited evidence to support the efficacy of RICE treatment. This study investigated whether physiotherapy (including RICE advice) was as effective as RICE advice alone in improving the time to recovery in a clinical situation.The evidence for RICE advice was reviewed along with the different treatment modalities currently used by physiotherapists in New Zealand for acute ankle sprain. This review highlighted the low number and poor quality of studies investigating RICE and early intervention physiotherapy management for ankle sprains. RICE principals appear to be relatively inexpensive and somewhat effective for pain relief and may reduce further tissue damage in the acute stage of Grade I and II ankle sprains. Evidence extrapolated from studies investigating the use of post surgical ice appears to support the use of ice in the acute stage of an ankle sprain to minimise bleeding and oedema. The intermittent application of ice is more effective for pain relief in the acute phase than sustained icing. Physiotherapy interventions such as TENS for pain relief and bracing for the support of Grade II - III ankle sprains have been shown to be beneficial for pain relief in the acute phase. A need for further high quality, randomised controlled trials (RCT's) was identified.Subsequently a RCT was conducted with 28 participants to investigate the difference between (a) early intervention physiotherapy management combined with RICE advice, and (b) self management RICE advice without physiotherapy.Twenty eight individuals (males n = 22, females n = 6), between the ages of 16 and 40 with acute ankle sprains, who met the inclusion criteria, were approached by physiotherapists working on this project and invited to participate. Dependant variables were pain, function, swelling, compliance and medication use up to Day 11 post injury. Swelling, pain and function were measured over three assessments on Days 1, 3 and 11, using volumetric analysis, a visual analogue scale (VAS) and a functional question derived from a validated functional questionnaire respectively. Medication use and compliance were elicited from information gathered in a participant home diary. Both groups were similar on Day 1 in respect to their initial pain, swelling, the number of participants who were referred for X-rays, and the time taken to present to the physiotherapist. However the RICE group had significantly higher function scores (p = 0.042). The RICE group also had a significantly higher use of medication on Day 1 (p = 0.035) and Day 11 (p = 0.048). For both groups there was a statistically significant decrease in swelling (p = 0.003), pain scores (p = 0.000), and an increase in function scores (p = 0.000) in relation to time over the eleven days of assessment. The physiotherapy group had significantly improved function scores (p = 0.042) from Day 1 to Day 11 compared to the RICE group. There were no significant differences between groups for swelling, pain scores, and their first day of documented non-compliance. The within day range of error in the volumetric measurements was within 189.9 ml and 1.2 ml. Three trials were conducted per person within a Day session. The first volumetric analysis was significantly less than the subsequent two measurements (p = 0.040).It was concluded that, in the early stage of an ankle injury both physiotherapy and RICE, and RICE advice alone, resulted in significant improvements in swelling, pain and function. Early intervention physiotherapy was significantly better at improving the functional ability of participants by Day 11. Early intervention physiotherapy may also identify complications associated with ankle sprains.Despite its limitations this research could potentially lead to changes in the standard treatment protocols for soft tissue ankle injuries. Implementation of self management RICE by patients in the acute stage would initially reduce the cost of physiotherapy treatments, and may lead to equal improvements in pain and swelling outcomes. However, it appears that physiotherapy may lead to better functional outcomes which would reduce the costs associated with time off work, and rehabilitation. It is important to note that these findings are based on a small sample size and on Grade I or II ankle ligament sprains, and that treatment for more severe ankle injuries may be better with physiotherapy, or surgery, rather than self management RICE by patients. Findings contribute to the growing body of 'best practice' evidence for health practitioners. Keywords: Acute soft tissue injuries, ankle, sprain, early intervention, physiotherapy, RICE, volumetric measurement.

Introdução: A entorse do tornozelo com lesão ligamentar é uma patologia muito prevalente nos ambulatórios de traumatologia. Objetivos: Considerando que inúmeros Municípios brasileiros não dispõem de aparelhos de ressonância nuclear magnética e devido ao alto custo desse exame, este trabalho avaliou a Radiografia de Estresse (RE) do tornozelo no diagnóstico das lesões ligamentares crônicas do complexo lateral do tornozelo, confirmados através da ressonância nuclear magnética (RNM). Métodos: Foram empregados os dois métodos de diagnóstico em 31 pacientes, de ambos os sexos, com idade entre 18 e 60 anos, que apresentaram entorse do tornozelo e lesão do complexo lateral do tornozelo retrospectivamente, com mais de 30 dias de evolução e que apresentavam alguma queixa clínica no tornozelo. Resultados: Dos 31 pacientes avaliados, 100% apresentaram lesão do ligamento fíbulo-talar anterior (LFTA) na RNM, e 14 pacientes (45%) apresentaram lesão do ligamento fíbulo-talar anterior e ligamento fíbulo-calcâneo (LFC). Na Radiografia de Estresse, evidenciou-se que 27 pacientes (87%) apresentavam algum grau de lesão ligamentar. Quando se avaliaram os 14 pacientes com lesão no ligamento fíbulo-talar anterior e fíbulo-calcâneo, a RE permitiu um diagnóstico positivo em 13 casos (92,8%). Conclusão: A Radiografia de Estresse é uma metodologia importante e de baixo custo no diagnóstico das lesões crônicas do complexo lateral do tornozelo. / Introduction: Ankle sprain with ligament injury is a very prevalent disease in ambulatory trauma. Purposes: Considering that many Brazilian towns do not have the nuclear magnetic resonance imaging (MRI) machines and the high cost of this examination, this study has evaluated the effectiveness of ankle stress radiographies (SR) in the diagnosis of chronic ligament injuries of the lateral ankle complex in patients previously diagnosed by clinical examination and confirmed by MRI. Methods: We have used both methods of diagnosis in 31 patients of both sexes, aged between 18 and 60, who had both an ankle sprain and lateral ankle complex injury retrospectively for more than 30 days and who had some clinical complaints. Results: From the 31 cases evaluated by MRI, 100% showed anterior talofibular ligament (ATFL) injury while 45% (14 patients) showed anterior talofibular ligament (ATFL) injury and calcaneofibular ligament (CFL) injury. On stress radiographies we have noticed that 27 patients (87%) had some degree of ligament injury. When we assessed 14 patients with anterior talofibular ligament (ATFL) injury and calcaneofibular ligament (CFL), the SR has given a positive diagnosis in 13 cases (92.8%). Conclusion: Stress radiography is an important and a low cost methodology in the diagnosis of chronic lesions of the lateral ankle complex.

Submitted by KARINA APARECIDA RODRIGUES null (kaarodrigues@gmail.com) on 2016-02-12T17:41:35Z No. of bitstreams: 1 A INFLUÊNCIA DA FADIGA NOS MÚSCULOS EVERSORES.pdf: 2242940 bytes, checksum: 172937512799242c5f55d9082f295349 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-02-15T11:30:53Z (GMT) No. of bitstreams: 1 rodrigues_ka_me_guara.pdf: 2242940 bytes, checksum: 172937512799242c5f55d9082f295349 (MD5) / Made available in DSpace on 2016-02-15T11:30:53Z (GMT). No. of bitstreams: 1 rodrigues_ka_me_guara.pdf: 2242940 bytes, checksum: 172937512799242c5f55d9082f295349 (MD5) Previous issue date: 2016-01-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A entorse do tornozelo em inversão e flexão plantar é uma das lesões mais comuns que ocorrem nas atividades de vida diária e no esporte. Embora os sintomas agudos possam se resolver rapidamente, muitos indivíduos relatam persistência de dor e instabilidade. Este tipo de lesão frequentemente acontece na fase final de um treino ou competição, e mesmo sabendo que a entorse é multifatorial, tal particularidade propicia estabelecer uma relação entre o evento da entorse e a fadiga. Diante disto, o presente estudo propõe analisar a latência e a intensidade de ativação dos músculos fibulares curto e longo em condições de fadiga, e ainda comparar indivíduos com estabilidade e instabilidade do tornozelo. Para esse fim, inicialmente foi desenvolvida uma plataforma simuladora da entorse em inversão e flexão plantar, na qual ambos os pés das voluntárias foram fixados e abaixo de onde se apoiava os pés foram acoplados transdutores de força, um de cada lado. Participaram do estudo 23 voluntárias do sexo feminino, fisicamente ativas, separadas em dois grupos: 11 fizeram parte do grupo estabilidade, não apresentavam histórico de lesão no complexo articular do tornozelo nos últimos 12 meses e outras 12 no grupo instabilidade funcional, classificadas pelo Questionário Cumberland Ankle Instability Tool. Para indução da fadiga, inicialmente foi registrada a Contração Isométrica Voluntária Máxima (CIVM) em eversão e flexão plantar. Durante a indução as voluntárias foram orientadas a manter 70% da CIVM. No momento em que a força aplicada fosse menor que 60% da CIVM o protocolo era interrompido e as voluntárias posicionadas em ortostatismo sobre a plataforma simuladora. Antes e após a fadiga foram realizadas dez simulações da entorse bilateralmente de forma randomizada e simultaneamente com o registro do sinal eletromiográfico. Assim, foi possível observar que após a fadiga não houve alteração da latência, no entanto ocorreu uma redução do nível de contração muscular, constatada pela diminuição da amplitude do sinal eletromiográfico. Ainda, não foram notadas diferenças entre os grupos estabilidade e instabilidade e verificouse maior atividade do músculo fibular curto quando comparado ao longo. Portanto, pôde-se concluir que o controle neuromuscular local ficou comprometido em situações de fadiga, devido à redução do nível de atividade dos músculos fibular longo e curto. Além disso, não foi possível observar diferença no comportamento muscular entre tornozelos estáveis e funcionalmente instáveis. / The inversion and plantar flexion ankle sprain is one of the most common injuries that occur in daily life activities and sports. Although acute symptoms can be resolved quickly, many people report persistent pain and instability. This type of injury often occurs in the final phase of a training or competition, and even though the sprain is multifactorial, such particularity provides the establishment of a relationship between the event sprain and fatigue. In this view, the present study aims to analyze the latency and activation intensity of the brevis and longus peroneus muscles in conditions of fatigue and also compare individuals with stability and instability of the ankle. For this purpose it was initially developed a simulated platform sprains in inversion and plantar flexion, in which both feet of the volunteers were fixed and below where rested his feet were coupled force transducers, one on each side. The study included 23 female volunteers, physically active, separated into two groups: 11 were part of the group stability, had no injury history in the joint complex of the ankle in the last 12 months and another 12 in functional instability group, classified by Cumberland Questionnaire Ankle Instability Tool. To induce fatigue, it was initially recorded a Contraction Isometric Maximal Voluntary (MVIC) in eversion and plantar flexion. During the induction, the participants were instructed to maintain 70% of the MVIC. At the time the force applied was below 60% of the MVIC the protocol was interrupted and the volunteers placed in standing position on the simulator platform. Before and after fatigue were held ten simulations sprain bilaterally randomly and simultaneously to record the electromyographic signal. Thus, it was observed that after the fatigue did not change the latency, but there was a reduction of muscle contraction level, evidenced by the reduction in amplitude of the electromyographic signal. Still, there were no noticeable differences between the groups stability and instability and there was a higher activity of the peroneus brevis compared to longus. Therefore, it was concluded that the local neuromuscular control was compromised in fatigue situations, due to reduced activity level of the peroneus longus and brevis muscles. Moreover, it was not possible to observe difference in muscle behavior between stable and unstable functionally ankles.

Introdução: A entorse do tornozelo com lesão ligamentar é uma patologia muito prevalente nos ambulatórios de traumatologia. Objetivos: Considerando que inúmeros Municípios brasileiros não dispõem de aparelhos de ressonância nuclear magnética e devido ao alto custo desse exame, este trabalho avaliou a Radiografia de Estresse (RE) do tornozelo no diagnóstico das lesões ligamentares crônicas do complexo lateral do tornozelo, confirmados através da ressonância nuclear magnética (RNM). Métodos: Foram empregados os dois métodos de diagnóstico em 31 pacientes, de ambos os sexos, com idade entre 18 e 60 anos, que apresentaram entorse do tornozelo e lesão do complexo lateral do tornozelo retrospectivamente, com mais de 30 dias de evolução e que apresentavam alguma queixa clínica no tornozelo. Resultados: Dos 31 pacientes avaliados, 100% apresentaram lesão do ligamento fíbulo-talar anterior (LFTA) na RNM, e 14 pacientes (45%) apresentaram lesão do ligamento fíbulo-talar anterior e ligamento fíbulo-calcâneo (LFC). Na Radiografia de Estresse, evidenciou-se que 27 pacientes (87%) apresentavam algum grau de lesão ligamentar. Quando se avaliaram os 14 pacientes com lesão no ligamento fíbulo-talar anterior e fíbulo-calcâneo, a RE permitiu um diagnóstico positivo em 13 casos (92,8%). Conclusão: A Radiografia de Estresse é uma metodologia importante e de baixo custo no diagnóstico das lesões crônicas do complexo lateral do tornozelo. / Introduction: Ankle sprain with ligament injury is a very prevalent disease in ambulatory trauma. Purposes: Considering that many Brazilian towns do not have the nuclear magnetic resonance imaging (MRI) machines and the high cost of this examination, this study has evaluated the effectiveness of ankle stress radiographies (SR) in the diagnosis of chronic ligament injuries of the lateral ankle complex in patients previously diagnosed by clinical examination and confirmed by MRI. Methods: We have used both methods of diagnosis in 31 patients of both sexes, aged between 18 and 60, who had both an ankle sprain and lateral ankle complex injury retrospectively for more than 30 days and who had some clinical complaints. Results: From the 31 cases evaluated by MRI, 100% showed anterior talofibular ligament (ATFL) injury while 45% (14 patients) showed anterior talofibular ligament (ATFL) injury and calcaneofibular ligament (CFL) injury. On stress radiographies we have noticed that 27 patients (87%) had some degree of ligament injury. When we assessed 14 patients with anterior talofibular ligament (ATFL) injury and calcaneofibular ligament (CFL), the SR has given a positive diagnosis in 13 cases (92.8%). Conclusion: Stress radiography is an important and a low cost methodology in the diagnosis of chronic lesions of the lateral ankle complex.

Introdução: A entorse do tornozelo com lesão ligamentar é uma patologia muito prevalente nos ambulatórios de traumatologia. Objetivos: Considerando que inúmeros Municípios brasileiros não dispõem de aparelhos de ressonância nuclear magnética e devido ao alto custo desse exame, este trabalho avaliou a Radiografia de Estresse (RE) do tornozelo no diagnóstico das lesões ligamentares crônicas do complexo lateral do tornozelo, confirmados através da ressonância nuclear magnética (RNM). Métodos: Foram empregados os dois métodos de diagnóstico em 31 pacientes, de ambos os sexos, com idade entre 18 e 60 anos, que apresentaram entorse do tornozelo e lesão do complexo lateral do tornozelo retrospectivamente, com mais de 30 dias de evolução e que apresentavam alguma queixa clínica no tornozelo. Resultados: Dos 31 pacientes avaliados, 100% apresentaram lesão do ligamento fíbulo-talar anterior (LFTA) na RNM, e 14 pacientes (45%) apresentaram lesão do ligamento fíbulo-talar anterior e ligamento fíbulo-calcâneo (LFC). Na Radiografia de Estresse, evidenciou-se que 27 pacientes (87%) apresentavam algum grau de lesão ligamentar. Quando se avaliaram os 14 pacientes com lesão no ligamento fíbulo-talar anterior e fíbulo-calcâneo, a RE permitiu um diagnóstico positivo em 13 casos (92,8%). Conclusão: A Radiografia de Estresse é uma metodologia importante e de baixo custo no diagnóstico das lesões crônicas do complexo lateral do tornozelo. / Introduction: Ankle sprain with ligament injury is a very prevalent disease in ambulatory trauma. Purposes: Considering that many Brazilian towns do not have the nuclear magnetic resonance imaging (MRI) machines and the high cost of this examination, this study has evaluated the effectiveness of ankle stress radiographies (SR) in the diagnosis of chronic ligament injuries of the lateral ankle complex in patients previously diagnosed by clinical examination and confirmed by MRI. Methods: We have used both methods of diagnosis in 31 patients of both sexes, aged between 18 and 60, who had both an ankle sprain and lateral ankle complex injury retrospectively for more than 30 days and who had some clinical complaints. Results: From the 31 cases evaluated by MRI, 100% showed anterior talofibular ligament (ATFL) injury while 45% (14 patients) showed anterior talofibular ligament (ATFL) injury and calcaneofibular ligament (CFL) injury. On stress radiographies we have noticed that 27 patients (87%) had some degree of ligament injury. When we assessed 14 patients with anterior talofibular ligament (ATFL) injury and calcaneofibular ligament (CFL), the SR has given a positive diagnosis in 13 cases (92.8%). Conclusion: Stress radiography is an important and a low cost methodology in the diagnosis of chronic lesions of the lateral ankle complex.

abstract: The human ankle is a critical joint required for mobility and stability of the body during static and dynamic activity. The absence of necessary torque output by the ankle due to neurological disorder or near-fatal injury can severely restrict locomotion and cause an inability to perform daily tasks. Physical Human-Robot Interaction (pHRI) has explored the potential of controlled actuators to positively impact human joints and partly restoring the required torque and stability at the joint to perform a task. However, a trade-off between agility and stability of the control technique of these devices can reduce the complete utilization of the performance to create a desirable impact on human joints. This research focuses on two control techniques of an Active Ankle Foot Orthosis (AFO) namely, Variable Stiffness (VS) and Variable Damping (VD) controllers to modulate ankle during walking. The VS controller is active during the stance phase and is used to restore the ankle trajectory of healthy participants that has been altered by adding a dead-weight of 2 Kgs. The VD controller is active during the terminal stance and early-swing phase and provides augmentative force during push-off that results in increased propulsion and stabilizes the ankle based on user-intuitions. Both controllers have a positive impact on Medial Gastrocnemius (GAS) muscle and Soleus (SOL) muscle which are powerful plantar - flexors critical to propulsion and kinematic properties during walking. The VS controller has recorded an 8.18% decrease in GAS and an 9.63 % decrease in SOL muscle activity during the stance phase amongst participants while decreasing mean ankle position error by 22.28 % and peak ankle position error by 17.43%. The VD controller demonstrated a 7.59 % decrease in GAS muscle and a 10.15 % decrease in SOL muscle activity during push-off amongst the participants while increasing the range-of-motion (ROM) by 7.84 %. Comprehensively, the study has shown a positive impact on ankle trajectory and the corresponding muscle effort at respective stages of the controller activity. / Dissertation/Thesis / Masters Thesis Mechanical Engineering 2020

Purpose: To determine the effect of Strain Counterstrain (SCS) on strength, dynamic balance and subjective sense of instability in individuals with chronic ankle instability (CAI). Subjects: Twenty seven volunteers (17 females and 10 males) between the ages of 18 and 55 (mean ± SD age: 33.6 ± 8.8) with a history of CAI who met the inclusion/exclusion criteria were randomly assigned to the control group (n= 13) and the experimental group (n=14). Methods: All subjects signed an informed consent, completed a demographic questionnaire and the foot and ankle ability measure (FAAM), and underwent a standard evaluation, ankle isokinetic testing and the star excursion balance test (SEBT) at the onset of the study. All subjects participated in a home exercise program and received a SCS treatment or a sham treatment once a week. At four weeks all subjects repeated the initial testing and completed a global rating of change (GROC) form. The primary aim was examined with a 2-way analysis of variance (ANOVA) with the treatment group (SCS versus sham) as the between subjects independent variable and time (baseline and four weeks) as the within subjects independent variable. Results: A significant group-by-time interaction was found for seven directions in the SEBT (p< 0.031) while no significant interaction was found for ankle strength (p>0.76). For subjective measures, no significant group-by-time interaction was found for the FAAM (p>0.548), but the GROC revealed a significant difference (p=0.014) in the mean score for the experimental group (3.92 ± 1.66) when compared to the control group (2.43 ± 1.66). Conclusions: Although SCS does not appear to have an effect on strength and subjective ankle function in subjects with CAI, it appears that SCS can lead to an improvement in dynamic ankle stability and the subjective sense of ankle instability. Recommendations: Continued research on the effectiveness of SCS in CAI and other sprain injuries is needed to confirm the results of this study. Given the significant rate of ankle sprain recurrence in this population, long-term studies are necessary. Lastly, very little evidence exists on the effects of SCS and the theoretical framework of this technique.