Title: Efficiency of cold treatment of locomotive system dysfunctions Objectives: The theoretical part should provide an overview of effects of cold on the human organism. The practical part reports a pilot study in which local cryotherapy was applied to painful areas of dysfunctional locomotive system. Methods: After measuring local painfulness using an algometer, the Cryogen 2 device was used for local cryotherapeutic treatment; after the treatment, algometer was used again. Subjective state of the patient was monitored throughout the process. Cryotherapy was applied within normal individual physiotherapeutic treatment to patients of varying age, sex, and locomotive system dysfunctions. Results: We have shown that local cryotherapy, using the Cryogen 2 device, did decrease painfulness in measured areas. Although significant differences in pain perception were found between male and female patients, the efficiency of cryotherapy did not depend on sex. Some correlation was found between treatment efficiency and age. No evidence was found for establishing that repeated application decreases pain perception measured before the next treatment. The results are influenced by a smaller sample of patients and measurements, and by inhomogeneity of patients. Key words: pain treatment, cold, local cryotherapy,...

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: When a soft tissue injury occurs the blood vessels and surrounding tissue are damaged leading to haemorrhaging and inflammation. Cryotherapy (cold therapy) is generally acknowledged as the preferable treatment by manual therapists during this immediate post-traumatic period of an injury. Cryotherapy has been shown to result in vasoconstriction decreasing the rate of blood flow which has a favourable effect on inflammation and pain. The commercially available cooling cuff is a relatively new cryotherapy modality offering a mechanism of cooling that does not require freezing and is easy to use. The polymer granules within the cooling cuff are activated by emersion in water therefore freezing is not required making the cooling cuff readily available compared to more traditional forms of cryotherapy. Aim: The aim of this study was to determine the effect of a moist ice pack and a commercially available cooling cuff radial artery blood flow (cm.s-1) and radial artery lumen diameter (mm) after 15 minutes of application. Method: This study was a pre-test post-test design utilising 43 asymptomatic participants that were randomly allocated to one of two groups. Each group either received a standard moist ice pack or a commercially available cooling cuff, placed on the ventral surface of the participants forearm, over the radial artery, for a duration of 15 minutes. Measurements were taken with a Doppler ultrasound to determine radial artery blood flow and lumen diameter, prior to the intervention and 15 minutes after the cryotherapy application. Data analysis was performed using IBM SPSS VERSION 20 (IBM Corp. Released 2010.IBM SPSS Statistics for Windows, Version 19.0. Armonk, New York: IBM Corp.). Statistical significance was set at a p< 0.05 level. Intra-group and inter-group comparisons were measured using repeated measures ANOVA testing. Results: Both the moist ice pack and commercially available cooling cuff resulted in a significant decrease in radial artery blood flow (p< 0.001) after 15 minutes of application with no significant changes being observed in radial artery diameter Conclusions: The commercially available cooling cuff resulted in a similar effect on radial artery blood flow and lumen diameter as moist ice, indicating that the commercially available cooling cuff may be utilised in the acute phase of an injury to alter blood flow. / M

Background: Acute pain is a globally occurring reason for inpatient suffering and the most common treatment is different forms of analgesics prescribed by doctors. The aim of this study is to identify effects of various non-pharmacological pain relief methods the registered nurse can offer patients with acute pain.   Method: This study is performed as a literature review to examine up to date evidence for non pharmacological pain relief alternatives. The literature search was made in the databases CINAHL, Cochrane and PubMed. A total of ten randomized controlled trial and three quasi experimental studies were included.   Results: When the studies were reviewed significant results were seen for complementary therapies. The results of the included studies showed that complementary therapies, such as cryotherapy, analgesic enhancement, massage, pain dissipation and activity, are effective non-pharmacologic alternatives the registered nurse can offer their patients. Included studies show few negative side effects and could be cost effective. Most of the included methods are easy to use and cost effective, while others are more complicated, expensive and need education to perform.   Conclusion: The study finds that several alternative pain relief methods, available for the registered nurse to offer, give effective relief for inpatients with acute pain. The knowledge of non pharmacological pain relief methods need to be encouraged when training to be a nurse and in the workfield of registered nurses. More research in the area is required to increase the evidence of the methods. / Bakgrund: Akut smärta är en globalt förekommande orsak till lidande hos människor och den vanligaste behandlingen är olika former av analgetika som förskrivs av läkare. Syftet med denna studie är att undersöka effekterna av olika icke-farmakologiska smärtlindringsmetoder som sjuksköterskan kan erbjuda inneliggande patienter.   Metod: Studien utformas som en litteraturöversikt för att undersöka aktuell evidens för icke-farmakologiska smärtlindringsalternativ. Sökningar gjordes i databaserna CINAHL, Cochrane och PubMed. Totalt inkluderades tio randomiserade kontrollerade studier och tre kvasiexperimentella studier.     Resultat: Efter granskning av studierna framkommer signifikanta resultat för smärtlindrande effekter av icke-farmakologisk smärtlindring. De inkluderade studiernas resultat visar att alternativa smärtlindringsmetoder, som kyla och värme, analgetikaförstärkning, massage, smärtavledning och aktivitet är effektiva komplement som sjuksköterskan kan erbjuda sina patienter. De studier som inkluderats beskriver dessutom få negativa effekter och vissa kostnadsbesparingar. De flesta icke-farmakologiska metoderna är enkla och kostnadseffektiva, medan andra är mer komplicerade, kräver utbildning och är kostsamma.   Slutsats: Studien finner att det finns flera effektiva icke-farmakologiska smärtlindringsmetoder, som sjuksköterskan kan erbjuda inneliggande patienter med akut smärta. Kunskaperna om icke-farmakologiska smärtlindringsalternativ inom sjuksköterskeutbildningarna bör uppdateras samt uppmuntras mer ute på avdelningarna. Vidare forskning inom området är nödvändigt för att öka evidensen ytterligare.

Submitted by JESSICA KIRSCH MICHELETTI null (jessicamicheletti@hotmail.com) on 2016-01-07T18:04:37Z No. of bitstreams: 1 JÉSSICA KIRSCH MICHELETTI.pdf: 1986588 bytes, checksum: dd0a0d26b8a3217f5d310580899619c8 (MD5) / Approved for entry into archive by Sandra Manzano de Almeida (smanzano@marilia.unesp.br) on 2016-01-08T15:53:32Z (GMT) No. of bitstreams: 1 micheletti_jk_me_prud.pdf: 1986588 bytes, checksum: dd0a0d26b8a3217f5d310580899619c8 (MD5) / Made available in DSpace on 2016-01-08T15:53:32Z (GMT). No. of bitstreams: 1 micheletti_jk_me_prud.pdf: 1986588 bytes, checksum: dd0a0d26b8a3217f5d310580899619c8 (MD5) Previous issue date: 2015-12-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A imersão em água fria (IAF) aparece no cenário atual como uma técnica recuperativa eficaz no meio esportivo, atuando sobre diferentes desfechos. Entretanto, o conceito de recuperação pós-exercício merece destaque, uma vez que análise de parâmetros isolados parece ferir esse conceito. Para tanto, a construção de um desenho a partir de um único mecanismo de estresse, com a mesma característica de aplicação de técnica e envolvendo elementos de dimensões diversas parece pertinente. Objetivo: analisar a recuperação após um treino imediato e verificar o comportamento isolados e em conjunto dos parâmetros clínicos, funcionais, metabólico e autonômico a partir do uso da IAF como técnica recuperativa. Métodos: Amostra composta por 64 jogadores de futebol do sexo masculino, randomizados em dois grupos, grupo controle (GC) e grupo experimental (GE). Os procedimentos foram realizados em duas etapas. 1ª: Participantes foram submetidos a testes basais de função muscular. 2ª: Após uma semana de descanso, foram submetidos a um treino chave (50 minutos) e imediatamente após realizaram a intervenção por 15 minutos, GE recebeu a IAF (13º±1ºC) e GC permaneceu sentado. As variáveis investigadas foram percepção subjetiva de dor, percepção de recuperação, alteração de sensibilidade, concentração de lactato sanguíneo, modulação autonômica cardíaca e os testes funcionais, estas foram mensuradas durante momentos específicos da recuperação até ao máximo 2 horas pós-treino chave. Para análise estatística utilizou-se o pacote estatístico SPSS Statistics 22.0. Para os dados numéricos, nos marcadores funcionais, a distribuição dos dados foi testada (Komolgorov-Smirnov) e como normal utilizou-se o teste t de Student para amostras independentes. Para os demais marcadores foram testados a esfericidade dos dados (teste de Mauchly). Os dados foram analisados utilizando a Análise de Variância para Medidas Repetidas (pós-teste de Bonferroni). Para os dados dicotomizados foi realizado para os dados de frequências relativa (%) da pontuação total (todos os desfechos) o teste Mann-Whitney. E para a frequência absoluta (de casos) o teste de qui-quadrado. Para calcular a probabilidade de recuperação foi utilizada regressão logística. Resultados: Dados numéricos: Para os desfechos clínicos, não foram observadas diferenças estatisticamente significantes entre os grupos, e ambos se recuperam no mesmo momento (15 minutos pós-treino chave). Para o desfecho metabólico, ambos os grupos se recuperaram no mesmo momento (2 horas pós-exercício). No desfecho função, não houve diferenças significantes entre momentos e entre grupos. Para análise da variabilidade da frequência cardíaca observou-se antecipação da recuperação de todos os índices no GE comparado ao GC. Dados dicotomizados: A análise em conjunto das categorias de variáveis não demonstrou melhor eficácia da técnica de IAF, em que o GC se recuperou 63,4% e o GE: 69,17. Quando avaliado os sistemas isolados há uma melhor probabilidade de chance da técnica em ser melhor para desfechos metabólico e autonômico. Conclusões: Gerais: Quando analisado em conjunto as categorias dos desfechos, as técnicas apresentam recuperações próximas, sem diferenças estatísticas. Específicos: Quando analisado as categorias de desfechos isoladas há elevada probabilidade de recuperação em até 2 horas pós-treino chave para participantes dos dois grupos nas variáveis clínicas, metabólica, autonômica e funcionais, exceção para o desfecho contração isométrica voluntária máxima (na análise dos dados dicotomizados). Para os conjuntos de variáveis metabólicas e autonômicas a probabilidade de recuperação mostrou-se maior para o GE (na análise dos dados dicotomizados). Por fim, o sistema autonômico é beneficiado com a técnica em ambas as análises. / Cold water immersion (CWI) appears in the current scenario as an effective recuperative technique in sports, working on different outcomes. However, the concept of post-exercise recovery deserves attention, since analysis of individual parameters seem to hurt this concept. Therefore, the construction of a drawing from a unique mechanism of stress, with the same technique application feature and involving elements of various dimensions seems pertinent. Objective: To analyze the immediately recovery after a training and to verify the isolated and combined behavior of clinical, functional, metabolic and autonomic parameters from the use of immersion in cold water as recuperative technique. Methods: A sample of 64 football players, randomized into two groups, control group (CG) and experimental group (EG). The procedures were performed in two stages. 1st: Participants underwent basic tests of muscle function. 2nd: After a week of rest, underwent a key workout (50 minutes) and immediately after the intervention performed for 15 minutes, GE received the IAF (13 ± 1 ° C) and GC stay sitting. The investigated variables were subjective perception of pain, perceived recovery, abnormal sensitivity, blood lactate concentration, cardiac autonomic modulation and functional tests, these were measured during specific recovery times up to a maximum two hours post training. Statistical analysis was performed using the statistical package SPSS Statistics 22.0. For numeric data, the functional markers, the distribution of the data was tested (Komolgorov-Smirnov) and as normal we used the t student test for independent samples. For the other markers were tested sphericity data (Mauchly test). Data were analyzed using analysis of variance for repeated measures (Bonferroni post-test). For dichotomized data was performed for data on frequency (%) of total score (all outcomes) Mann-Whitney test. And the absolute frequency (cases) chi-square test. To calculate the probability of recovery was used logistic regression. Results: numerical data: For clinical outcomes, statistically significant differences were observed between the groups, and both recover at the same time (15 minutes post training). For metabolic outcomes, both groups recovered at the same time (2 hours after exercise). The function outcome, there were no significant differences between moments and between groups. For the analysis of heart rate variability was observed anticipation of recovery of all indices in the EG compared to the CG. Dichotomized data: Analysis together variable categories did not show better efficacy CWI technique where the GC has recovered 63.4% and GE: 69,17. When assessed isolated systems there is a better chance of technique likely to be better for metabolic and autonomic outcomes. Conclusions: General: When analyzed together the categories of outcomes, the techniques presented close recoveries, with no statistical differences. Specific: When analyzed the categories of isolated outcomes there is high probability of recovery within 2 after training hours for participants of the two groups in clinical, metabolic, autonomic and functional, except for the outcome of maximal voluntary isometric contraction (in the analysis of dichotomized data). For groups of metabolic and autonomic variables the probability of recovery was higher for the GE (in the analysis of dichotomized data). Finally, the autonomic system is benefit from the technique in both analyses.

Submitted by TATIANA EMY KOIKE null (tatikoike@yahoo.com) on 2016-03-10T11:09:02Z No. of bitstreams: 1 Encadernaçao Mestrado UNESP- Tatiana Emy Koike.pdf: 1535953 bytes, checksum: 25ca75a268f1c6bf7d7ca80e833b9cbd (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-03-10T20:19:49Z (GMT) No. of bitstreams: 1 koike_te_me_prud.pdf: 1535953 bytes, checksum: 25ca75a268f1c6bf7d7ca80e833b9cbd (MD5) / Made available in DSpace on 2016-03-10T20:19:49Z (GMT). No. of bitstreams: 1 koike_te_me_prud.pdf: 1535953 bytes, checksum: 25ca75a268f1c6bf7d7ca80e833b9cbd (MD5) Previous issue date: 2016-02-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Muscle injuries are often cause due to the practice of sports and recreational activities. Because of its high incidence, it is important to research the treatments that promote quality in the muscle and shorter repair process. To evaluate the effect of the combination of the therapeutic resources of Cryotherapy and Therapeutic Ultrasound in the treatment of muscle damage by impact. 55 Wistar rats was separate into groups, Acute Injury (AI), Injury (I), Cryotherapy (CR), Therapeutic Ultrasound (TU), Cryotherapy and Therapeutic Ultrasound (CRTU). All animals were anesthetize and muscle damage due to impact by the release of a load of 200 g at 30 cm. Then received treatments as allocated group and CR protocol using ice bag for 20 minutes and TU for five minutes with an intensity of 0.5W / cm2 and the frequency of 1MHz. Euthanasia was performed by intraperitoneal administration of overdose of Xylazine and Ketamine. The collection of the gastrocnemius muscle for the Body and Muscle mass analysis, histological analysis and fractal dimension of inflammation and collagen gene quantification of mRNA (TNF-α and TGF-β1). Data analysis was performed using SPSS for Windows 22. The Shapiro-Wilk test to verify the normality of the data was performed. When data showed normal, we used t test for paired samples test and one-way ANOVA followed by Tukey’s post-test. When it violated the normality of the data, followed by the Kruskal- Wallis test with Dunn’s post-test. For all analyzes was adopted the significance level of 5%. Among all groups, the CRTU lose less body and muscle mass, improved morphometry, besides presenting collagen reduction by DF compared to AI and CR (p <0.05). With regard to the inflammatory process CRTU group showed a significant reduction of DF in relation to the AI groups (p = 0.001), I (p = 0.001) and CR (p = 0.007), and TU reduced the DF significantly relative to AI groups (p = 0.001), I (p = 0.001) and CR (p = 0.036). The reduction of TNF-α was significant in TU group compared with AI groups (p = 0.008); I (p = 0.032) and CR (p = 0.046) and TGF- β1 in the CR group compared to AI (p = 0.001) and I (p = 0.006), in the TU group compared to AI (p = 0.049) and CRTU compared to AI (p = 0.023). The combination treatment was superior to the results presented by the isolated treatments in the muscle repair process. Observed by reducing the loss of body and muscle mass, improved histological appearance and reduction of collagen. / As lesões musculares são frequentemente ocasionadas em decorrência da prática de atividades esportivas e recreativas. Devido sua alta incidência, é importante pesquisar os tratamentos que promovam qualidade no processo de reparação muscular e menor duração. Avaliar o efeito da combinação dos recursos terapêuticos de Crioterapia e Ultrassom Terapêutico no tratamento de lesão muscular por impacto. 55 ratos wistar foram separados em Grupos Lesão Aguda (LA), Lesão (L), Crioterapia (CR), Ultrassom Terapêutico (US), Crioterapia e Ultrassom Terapêutico (CRUS). Todos os animais foram anestesiados e submetidos à lesão muscular por impacto pela liberação de uma carga de 200g a 30 cm de altura. Em seguida receberam os tratamentos conforme grupo alocado, sendo o protocolo de CR por meio de bolsa de gelo durante 20 minutos e o US durante cinco minutos com intensidade de 0,5W/cm2 e frequência de 1MHz. A eutanásia foi realizada por administração intraperitoneal de superdosagem de Xilazina e Ketamina, para subsequente coleta do músculo gastrocnêmio destinado às análises de massa Corporal e Muscular, análises Histológica e Dimensão Fractal do processo inflamatório e de colágeno, Quantificação gênica de RNAm (TNF-α e TGF-β1). A análise dos dados foi realizada utilizando o programa estatístico SPSS 22 for Windows. Foi realizado o teste de Shapiro-Wilk para verificação da normalidade dos dados. Quando os dados apresentaram normalidade, foi utilizado teste T para amostras pareadas e teste de Anova one-way, seguido pelo pós-teste de Tukey. Quando violada a normalidade dos dados, seguiu-se com o teste de Kruskall-Wallis, com pós-teste de Dunn. Para todas as análises foi adotado o nível de significância de 5%. Dentre todos os grupos, o CRUS perdeu menos massa corporal e muscular, melhora da morfometria, além de apresentar redução de colágeno pela DF em comparação aos LA e CR (p < 0,05). Com relação ao processo inflamatório, grupo CRUS apresentou redução significante da DF em relação aos grupos LA (p = 0,001), L (p = 0,001) e CR (p = 0,007), e o US reduziu a DF significativamente em relação aos grupos LA (p = 0,001), L (p = 0,001) e CR (p = 0,036). A redução de TNF-α foi significante no grupo US comparado com grupos LA (p = 0,008); L (p = 0,032) e CR (p = 0,046), e TGF-β1 no grupo CR em comparação aos LA (p = 0,001) e L (p = 0,006), no grupo US em comparação ao LA (p = 0,049), e CRUS em comparação aos LA (p = 0,023). A associação de tratamentos foi superior aos resultados apresentados pelos tratamentos isolados no processo de reparação muscular. Observado pela redução da perda de massa corporal e muscular, melhora do aspecto histológico e redução de colágeno.

Made available in DSpace on 2016-06-02T20:19:06Z (GMT). No. of bitstreams: 1 DissPRC.pdf: 1620178 bytes, checksum: 0a7281e175babc5ee5b1017fd36a1d02 (MD5) Previous issue date: 2007-02-28 / Financiadora de Estudos e Projetos / This study evaluated the effectiveness of a standardized supervised therapeutic program performed during working hours on physical function and pain in workers with shoulder impingement stages I and II. Methods: Fourteen assembly line male workers (31.93 ± 5.86 years) with unilateral shoulder impingement stages I and II. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire evaluated function of the upper limbs. The McGill Pain Questionnaire quantified the pain by the number of words chosen and the pain rating index (PRI). Physical performance was evaluated by torque, total work and acceleration time that were measured bilaterally during isokinetic concentric abduction and lateral and medial rotations in the scapular plane, at 60°/s and 180°/s. Subjects completed an eight-week intervention program, consisting of cryotherapy, strengthening and stretching exercises, performed twice a week during working hours, and they were evaluated pre- and post-intervention. Results: DASH scores improved (P < 0.05) and the number of words chosen and PRI decreased (P < 0.05) at post-intervention. Torque improved (P < 0.05) in the abduction at 60°/s and in the medial rotation for both speeds after the therapeutic intervention. Total work increased (P < 0.05) at post-intervention for abduction and medial rotation at 60°/s and 180°/s. Acceleration time decreased (P < 0.05) in the abduction at 180°/s compared to the pre-intervention period. No changes were observed (P > 0.05) in any variable during lateral rotation. Conclusion: A rehabilitation program performed during working hours seems to improve symptom and physical performance in workers with shoulder impingement stages I and II. / Este estudo avaliou a efetividade um programa terapêutico, supervisionado e padronizado e realizado durante a jornada de trabalho, na função física e na dor de trabalhadores portadores da síndrome do impacto graus I e II. Métodos: Foram avaliados quatorze trabalhadores (idade média de 31,93 ± 5,86 anos), do sexo masculino, de uma linha de produção de uma indústria de material escolar portadores da síndrome do impacto unilateral, graus I e II de Neer.O questionário Disabilities of the Arm, Shoulder and Hand (DASH) avaliou a função do membro superior. Por meio do questionário McGill de dor, a dor foi quantificada pelo número de palavras escolhidas e pelo índice de avaliação da dor (IAD). O desempenho físico foi avaliado por meio do torque, trabalho total e tempo de aceleração que foram medidos bilateralmente durante movimentos isocinéticos concêntricos de abdução e rotação lateral e medial, no plano da escápula, a 60°/s e 180°/s. Os sujeitos realizaram, durante a jornada de trabalho, um programa de intervenção que consistiu de crioterapia, fortalecimento com bandas elásticas e alongamento. A intervenção foi realizada duas vezes por semana, por oito semanas. A avaliação foi realizada pré e pósintervenção. Resultados: No período pós-intervenção, as pontuações do DASH melhoraram (P < 0,05) e o número de palavras escolhidas e o IAD diminuíram (P < 0,05). O torque melhorou (P < 0,05) na abdução a 60°/s e na rotação medial em ambas as velocidades após o período de intervenção terapêutica. O trabalho total aumentou (P < 0,05), após a intervenção, na abdução e na rotação medial a 60°/s e 180°/s. O tempo de aceleração diminuiu (P < 0,05) na abdução a 180°/s quando comparado ao período préintervenção. Não houve alterações (P > 0,05) em nenhuma variável durante a rotação lateral. Conclusão: Um programa de reabilitação realizado durante a jornada de trabalho parece melhorar os sintomas e a função dos trabalhadores portadores da síndrome do impacto graus I e II de Neer.

Made available in DSpace on 2016-06-02T19:22:55Z (GMT). No. of bitstreams: 1 4273.pdf: 640166 bytes, checksum: 0c9fc1f3e1c6ddb8472d73914461506a (MD5) Previous issue date: 2012-03-30 / Universidade Federal de Sao Carlos / Although tissue cooling is widely used in the treatment of musculoskeletal disorders there is still controversy about its effects on muscular performance. It is important to study this issue since cooling is also combined with exercise. Objective. To compare the effects of ice pack and cold water immersion on the muscular performance parameters of plantar flexors and electromyography (EMG) activity of the triceps surae. Design. Subjects were randomly assigned treatment with either ice pack (n=20) or cold water immersion (n=21). Independent variables were cold modality (ice pack or cold water immersion), muscle action (isometric and concentric isokinetic, angular velocity of isokinetic test (60 and 120°/s) and measurement time (pre- and post-cooling). Dependent variables were skin temperature, muscular performance and EMG activity. Methods. The sample included 41 healthy men with a mean age of 22.15 (SD=2.89). In each group one of the two cold modalities was applied to the calf region for 20 minutes. Skin temperature, plantar flexors muscular performance parameters and EMG activity of the triceps surae were measured before and after cooling. Results. Ice pack increased isometric peak torque. Both cold modalities reduced EMG activity in both muscles during isometric contraction. Both cold modalities reduced peak torque and total work during isokinetic contraction at both velocities. Ice pack was more effective at reducing EMG activity in isokinetic contractions. Limitations. The examiner was not blinded regarding treatment group and the population included only young healthy participants. Conclusions. Ice pack and cold water immersion showed similar effects on muscular performance, which depends on the muscle action performed. Cooling decreased isokinetic performance and the ice pack increased isometric torque. The results suggest that caution is required when performing activities after cooling, especially tasks involving maximal isokinetic contractions. / Embora o resfriamento tecidual seja amplamente utilizado no tratamento de lesões músculo esqueléticas há ainda controvérsias sobre seus efeitos no desempenho muscular. Estudar esse aspecto é importante uma vez que o resfriamento também é utilizado associado a exercícios físicos. Objetivo: Comparar os efeitos do pacote de gelo e da imersão em água gelada sobre parâmetros do desempenho muscular dos flexores plantares e atividade eletromiográfica (EMG) do tríceps sural. Desenho: Foi realizado um estudo experimental com distribuição aleatória dos participantes em dois grupos de intervenção, pacote de gelo (n=20) e imersão em água gelada (n=21). As variáveis independentes foram grupo experimental (pacote de gelo ou imersão em água gelada), tipo de contração (isométrica ou isocinética concêntrica), velocidade angular do teste isocinético (60 e 120°/s) e tempo de mensuração (pré- e pós-resfriamento). Variáveis dependentes foram temperatura da pele, parâmetros de desempenho muscular e atividade EMG. Métodos: Quarenta e um homens saudáveis, com média de idade (DP) de 22,15 (2,89) anos participaram do estudo. Cada grupo recebeu uma das duas modalidades de resfriamento, aplicada sobre a região da panturrilha por 20 minutos. A temperatura da pele e parâmetros do desempenho muscular dos flexores plantares e da atividade EMG dos músculos sóleo e gastrocnêmio medial e lateral foram avaliados antes e imediatamente após o resfriamento. Resultados: O pacote de gelo causou aumento no pico de torque isométrico. A atividade EMG foi reduzida em ambos os músculos sóleo e gastrocnêmio pelas duas modalidades de resfriamento durante a contração isométrica. As duas modalidades de resfriamento reduziram o pico de torque e trabalho total na contração isocinética em ambas as velocidades avaliadas. De modo geral, o pacote de gelo foi mais efetivo para reduzir a atividade EMG na contração isocinética. Conclusões: O pacote de gelo e a imersão em água gelada mostram efeitos similares sobre o desempenho muscular, o qual é dependente a ação muscular realizada. O resfriamento muscular diminui o desempenho durante a contração isocinético e o pacote de gelo aumenta o torque isométrico. Os resultados sugerem cautela quando forem realizadas atividades dinâmicas após o resfriamento, especialmente durante contrações isocinéticas máximas.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Skeletal muscle injuries are among the most frequent causes of functional impairment in muscle tissue, affecting the life quality and are primarily responsible for the loss of rhythm in the case of training athletes. The skeletal muscle lesion most frequent are contusion and strain injury. Thus, developing therapies that mitigate and might accelerate the rehabilitation process of injured tissue are of great importance. For this reason, therapeutic applications of physical agents are gaining prominence, especially in sports medicine for the treatment of skeletal muscle injury, but do not have the mechanism of action fully understood. This study was performed in order to examine whether the modulation of oxidative stress could be an important factor involved in the beneficial effect of cryo and thermoterapy on strain gastrocnemius muscle injury. Adult male Wistar rats were submitted to a strain injury and treated with the therapeutic agents in an isolated or combined form. Strain damages caused an increase in muscle and blood oxidative damage. We suggest that this oxidative damage is possible related to the impairment of the muscle cells structure since that we observed a significant positive correlation among the increase in plasma Creatine Kinase levels and in muscle and blood Dichlorofluorescein oxidized and Thiobarbituric acid reactive substance levels. The inflammatory response intensity seems to be also an important factor involved in the genesis of the oxidative damage in the initial moments that follows the muscle strain injury. The therapeutic cold seems to be more effective to prevent the damage induced by the strain injury possible due to its capacity to control the muscle cells structure impairment and also to modulate the inflammatory response intensity that follows a muscle strain injury. / Lesões musculares esqueléticas estão entre as causas mais frequentes de comprometimento funcional do tecido muscular, acometendo a qualidade de vida e são as principais responsáveis pela perda do ritmo de treinamento no caso de atletas. As lesões mais frequentes são as contusões e distensões musculares. Assim, o desenvolvimento de terapias que amenizem e possam acelerar o processo de reparo celular e reabilitação tecidual são de grande importância. Desta forma, aplicações terapêuticas de agentes físicos estão ganhando destaque, principalmente na medicina desportiva, no tratamento de lesões musculares esquelética, porém, não apresentam o mecanismo de ação totalmente esclarecido. Este estudo foi realizado para examinar se a modulação do estresse oxidativo poderia ser um importante fator envolvido nos efeitos benéficos da crio e da termoterapia na injuria por distensão no músculo gastrocnemius. Ratos machos Wistar adultos foram submetidos à distensão muscular e tratados com agentes terapêuticos físicos, frio e calor, de forma isolada ou combinada. A lesão por distensão causou um aumento nos marcadores de dano oxidativo, tais como a formação de espécies reativas e peroxidação lipídica no músculo e no sangue. Nós sugerimos que este dano oxidativo é possivelmente relacionado a um prejuízo da estrutura da célula muscular, assim, observamos uma significante correlação positiva entre o aumento nos níveis plasmáticos de Creatina Quinase e no músculo e sangue níveis de Diclorofluoresceina oxidada e substâncias reativas ao ácido tiobarbitúrico. A intensidade da resposta inflamatória parece ser também um importante fator envolvido na gênese do dano oxidativo nos momentos iniciais a lesão. O frio terapêutico parece ser o mais efetivo em prevenir o dano induzido pela distensão muscular possivelmente devido a sua capacidade em modular os danos à estrutura da célula muscular e também a intensidade da resposta inflamatória que segue a injuria músculo esquelética.

Made available in DSpace on 2014-12-17T15:16:07Z (GMT). No. of bitstreams: 1 FabioLM.pdf: 1201794 bytes, checksum: a0d59fd87797a00a671d5be8a4198404 (MD5) Previous issue date: 2009-10-29 / Funda??o de Amparo a Pesquisa do Estado de S?o Paulo / Cerebrovascular accident (CVA) is a term used to characterize an ischemic or hemorrhagic vascular injury, which has got as main clinic manifestations, the motor and reflex function disturbance. In the first stage there is flaccidity and loss of voluntary movements that afterwards is substituted by mass patterns and spasticity. The spasticity brings with itself functional deficits and can generate negative impacts in various motor patterns. The aim of this research was to investigate the hyperreflexia and identify the immediate effects of transcutaneous nervous stimulation (TENS) and cryotherapy in the spasticity and electromyographic activity of hemiparetic subjects. The study is characterized as an almost experimental type, in which were selected, to compose the sample, 16 patients of both sex with CVA sequel. These individuals were evaluated by collecting the amplitude peak to peak and H reflex latency, Motor response (M response) in solear muscle and the electromyography (EMG) of the injured and healthy legs anterior tibial muscles. In the injured limb the evaluations occurred in different days for cryotherapy, TENS and control, in two moments, before and after the interventions. The healthy limb was evaluated one single time to serve as baseline, for comparison with the injured limb. It was used an statistic analysis, the t paired student test to identify the H reflex differences, latency and EMG of the injured and healthy limbs and to compare the results before and after the recourses application. The ANOVA for related samples was used to identify the differences among the recourses used. It was attributed for the statistic tests a significance level of 5%. The amplitude peak to peak of normalized maximum H reflex through the maximum motor response (Hmax/Mmax), showed itself significantly increased in the injured limb (p=0.0245). The H reflex latency was presented reduced in the injured limb (p=0, 0375). The electromyographic activity was showed decreased in the injured limb (p< 0.0001). After the TENS there was a Hm?x/Mm?x ratio decrease (0.60?0.16 versus 0.49.?0.18; P = 0.0006). Nonetheless, Just after the cryotherapy application there was an increase of Hm?x/Mm?x ratio (0.58 ? 0,15 to 0.77 ? 0.13, P=0,0007) and increase of signal latency (30.41 ? 1.87 versus 33.24 ? 2.19; P=0.0001). The electromyographic activity wasn t altered significantly by any resource. It was met statistic significant differences when the Hm?x/Mm?x P<0.0001) ratio and H reflex latency (P<0.0001) were compared between the post TENS, cryotherapy and control. One can conclude that the TENS can be used to spasticity immediate reduction, and that the cryotherapy can increase the hyperreflexia state in spastic patients. Nonetheless, the spasticity decrease or increase didn t provoke lectromyographic activity change in the muscle that is opponent to the spastic one / Acidente Vascular Encef?lico (AVE) ? o termo empregado para caracterizar uma les?o vascular isqu?mica ou hemorr?gica, que tem como principais manifesta??es cl?nicas, o dist?rbio da fun??o motora e reflexa. No est?gio inicial h? presen?a de flacidez e falta de movimentos volunt?rios, que posteriormente ? substitu?do por padr?es em massa e espasticidade. A espasticidade traz consigo d?ficits funcionais e pode gerar impactos negativos em diversos padr?es motores. O objetivo da pesquisa foi investigar os efeitos imediatos da eletroestimula??o nervosa transcut?nea (TENS) e crioterapia na espasticidade e na atividade eletromiogr?fica de sujeitos hemipar?ticos. O estudo caracteriza-se por ser do tipo quase experimental, no qual foram selecionados para compor a amostra, 16 pacientes de ambos os sexos com sequela de AVE. Estes indiv?duos foram avaliados captando-se a amplitude pico a pico e lat?ncia do reflexo H, resposta Motora (resposta M) no m?sculo solear e o eletromiograma (EMG) do m?sculo tibial anterior do membro comprometido e n?o comprometido. No membro comprometido as avalia??es ocorreram em dias diferentes para crioterapia TENS e controle, em dois momentos, antes e depois das interven??es. O membro n?o comprometido foi avaliado uma ?nica vez para servir como linha de base, para compara??o com o membro comprometido. Utilizou-se na an?lise estat?stica, o test t de student pareado para identificar as diferen?as do reflexo H, lat?ncia e EMG do membro comprometido e n?o comprometido e para comparar os resultados antes e depois da aplica??o dos recursos. A ANOVA para amostras relacionadas foi utilizada para identificar as diferen?as entre os recursos utilizados. Atribuiu-se para os testes estat?sticos o n?vel de signific?ncia de 5%. A amplitude pico a pico do reflexo H m?ximo normalizado pela resposta motora m?xima (Hm?x/Mm?x), mostrou-se significativamente aumentada no membro comprometido (p=0.0245). A lat?ncia do reflexo H reduziu no membro comprometido, com essa redu??o sendo estatisticamente significativa (p=0,0375). A atividade eletromiogr?fica se mostrou diminu?da no membro comprometido (p< 0.0001). Depois da TENS houve uma diminui??o da rela??o Hm?x/Mm?x (0.60?0.16 versus 0.49.?0.18; P = 0.0006). No entanto, logo ap?s a aplica??o do gelo houve um aumento da rela??o Hm?x/Mm?x (0.58 ? 0,15 para 0.77 ? 0.13, P=0,0007) e aumento da lat?ncia do sinal (30.41 ? 1.87 versus 33.24 ? 2.19; P=0.0001). A atividade eletromiogr?fica n?o foi alterada significativamente por nenhum recurso. Foram encontradas diferen?as estatisticamente significativas quando a raz?o Hm?x/Mm?x (P<0.0001) e lat?ncia do reflexo H (P<0.0001) foram comparadas entre o p?s-TENS, P?s- crioterapia e controle. Pode-se concluir que a TENS pode ser utilizada para fins de redu??o imediata da espasticidade, e que a crioterapia pode aumentar o estado de hiperreflexia nos pacientes esp?ticos. Entretanto, a diminui??o ou o aumento da espasticidade n?o ocasionou altera??o na atividade eletromiogr?fica do m?sculo antagonista ao esp?stico

La cryothérapie est utilisée de manière large et empirique à visée adjuvante dans les rhumatismes inflammatoires, avec un niveau de preuve faible. Dans une revue systématique de la littérature, en poolant les données de 6 études non contrôlées, nous avons pu démontrer que la cryothérapie (locale ou corps entier) appliquée deux fois par jour pendant 7 à 15 jours réduisait significativement l'EVA douleur et le score d'activité DAS25 dans la polyarthrite rhumatoïde. La cryothérapie locale (glace ou gaz froide) montrait par ailleurs des effets taille intra-classes supérieurs à ceux obtenus en utilisant la cryothérapie corps entier. L'objectif de ce travail était de mesurer les effets de la cryothérapie locale sur al douleur, l'inflammation synoviale et systémique chez les patients arthritiques et dans le modèle murin d'arthrite à l'adjuvant. Dans les études randomisées CDRI et ALGGAR, nous avons évalué les effets de deux applications locales de froid (glace versus gaz froid) sur la douleur, l'activité Doppler et les taux protéiques de cytokines intra-articulaires controlatéraux non souffrant d'arthrites de genou non septiques. Les genoux arthritiques controlatéraux non traités étaient utilisés comme contrôles. Nous avons par ailleurs étudié in vitro les effets de l'hypothermie modérée (30°C pendant 2heures) sur l'expression protéique des cytokines dans un modèle de culture de rotules de rats arthritiques. Nous avons enfin étudié in vitro dans l'arthrite à l'adjuvant les effets de l'application sub-chronique de glace ou de gaz froid (2 fois par jour pendant 14 jours versus contrôles arthritiques non traités) sur le score d'arthrite, le diamètre de cheville, la transcription des gènes codant pour les cytokines pro-inflammatoires dans les pattes arrières (Q-RT-PCR) et l'expression protéique des cytokines dans le plasma (Multiplex et ELISA) après 14 jours de traitement. Dans l'étude CDRI, la cryothérapie locale (glace et gaz froid) réduisait significativement l'EVA douleur ainsi que le score Doppler dans les genoux traités, ces effets persistant le lendemain des deux applications. Dans une analyse intermédiaire des résultats de l'étude ALGGAR, en combinant les deux groupes de traitement (glace et gaz de froid), nous avons observé une baisse des taux d'IL-6, d'IL-1β et de VEGF dans le liquide articulaire arès deux applications. dans les cultures d'explants de rotules de rats arthritiques, l'hypothermie ponctuelle réduisait significativement les taux d'IL-6, IL-17A et IL-1β dans les pattes arrières après 14 jours de traitement. Les deux modalités réduisaient significativement les niveaux plasmatiques d'IL-17A et la glace réduisait en outre les taux d'IL-6 et de VEGF. Nous n'avons observé aucun effet de la cryothérapie locale sur le voie du TNF-α chez l'homme ni chez l'animal. Nos résultats démontrent pour la première fois un effet thérapeutique et anti-inflammatoire de la cryothérapie locale dans l'arthrite. Les effets biologiques était IL-6/IL-147 dépendants et TNF-α indépendants. Des études complémentaires permettront de mieux caractériser les mécanismes moléculaires sous-jacents et de déterminer su la cryothérapie locale pourrait être une alternative aux AINS et corticoïdes dans les rhumatismes inflammatoires. / Cryotheapy i widely and empirically used in an adjuvant setting in inflammatory rheumatic diseases, with a low level of evidence. We performed a systematic review of the literature and, by pooling data from 6 non-controlled studies, we could show that local cryotherapy (local or whole-body cryotherapy) applaied twice a day for 7-15 days significantly reduced the pain VAS and the DAS28 activity score in rheumatoid arthritis. Furthermore, local cryotherapy (ice packs or cold gas) showed significantly greater intra)class effect-sizes compared to whole-body cryotherapy. The aim of this work was to measure the effects of local cryotherapy on pain, synovial and systemic inflammation in arthrici patients and in the murine model of adjuvant-induced arthritis. First, in the CDRI and ALGGAR randomized studies, we evaluated the effects of 2 local cold applications (ice versus cold gas) on pain, power Doppler activity and intra-joint cytokine protein levels in 46 patients suffering from non-septic knee arthritides. Contralateral arthritic knee were used as control. Secondly, we studied the in vitro effects of mild hypothermia (30°C for 2 hours) on cytokine protein expression in a model of cultured arthritic rat patellae. Thidly, we studied the in vitro effects of sub-chronically applied ice or cold gas (twice a day for 14 days versus non-treated arthritic controls) on the arthritis score, the ankle diameter, pro-inflammatory cytokine gene transcription levelsin hind paws (Q-RT-PCR) and cytokine plasma protein levelx (Multiplex and ELISA) after 14 days of treatment. In the CDRI study, local cryotherapy (ice and cold gas) significantly reduced the pain VAS and the power Doppler score in treated kness, and these effects remained significant the day afetr 2 cold applicaitions. In an intermediate analysis of the ALGGAR study results, by pooling the 2 treatment groups, we could show significant decreases in IL-6 protein, IL-1β and VEGF synovial fluid protein levels after 2 cold applicatios. In arthritic rat patella explangt culture experiments, punctual hypothermia significantly reduced IL-6 protein levels. In vivon ice was more efficient on the clinical parameters and better tolerated compared to cold gas. Both techniques significantly reduced IL-6, IL-17A ans IL-1β gene transcription levels in hind paws after 14 days of treatment. Both techniques redcued IL-17A plasma protein levles, while ice also reduced IL-6 and VEGF plasma protein levels. Conversely, we observed no effect of local cryotherapy on the TNF-α pathway, neither in patients nor in our animal model. Here we demonstrate for the first time therapeutic and anti-inflammatory effet-cts of local cryothepary in arthritis. The biological effects were IL-6/IL-17-driven and TNF-α independent. Further studies will help elucidate the underlying molecular mlechanisms involved and detemrine whether local cryotherapy might be a safer alternative to NSAIDs ans corticosteroids in inflammatory rheumatic diseases.