Syfte och frågeställningar: Syftet med studien var att undersöka om slingträning av nedre bålen för individer med löparknä kan ge en reducering av skadeproblematiken. Syftet var även att studera om upplevelsen av smärta och begränsning i aktivitet förändrats hos dessa individer i en subjektiv bedömning. Löparknä innebär smärta på den yttre sidan av knät, mest vanligt hos löpare men även andra idrottare drabbas. Frågeställningar: I vilken omfattning kan slingträning av nedre bålen för individer med löparknä ge en mer funktionell styrka och även större uthållighet? Hur upplever individer med löparknä vid en subjektiv skattning att denna träning leder till en förändring av smärta och begränsning i aktivitet? Metod: Studien genomfördes som en kvantitativ experimentell studie, där en interventionsgrupp på sex löpare med löparknäproblem genomförde slingträning av nedre bålen. Detta skedde två gånger i veckan under sex veckor. Tester av funktionell styrka och uthållighet genomfördes den första veckan, efter tre veckor och efter sex veckor. Testerna innebar ett isometriskt test av höftabduktorer, ett balanstest på ett ben och att samtidigt sträcka sig framåt på samma sida, ett balanstest på ett ben med sträckning över huvudet i frontalplan, och ett test av svag länk vid sidliggande höftabduktion. En kontrollgrupp på fyra löpare utan skador genomförde enbart testerna vid samma tidpunkter. Därtill följde en subjektiv bedömning, i form av skattning på en skala 0-10, av hur individen upplevde smärta av löparknät, samt hur det begränsade hans/hennes aktivitet. Resultat: En signifikant förbättring över tid erhölls i både det skadade och friska benet hos interventionsgruppen i tre av testerna, närmare bestämt isometriskt test av höftabduktorer (51 %), balanstest på ett ben med sträckning över huvudet i frontalplan (8 %), och test av svag länk vid sidliggande höftabduktion (27 %). Ingen förändring erhölls hos kontrollgruppen. Slutsats: Denna studie tyder på att slingträning av nedre bålen för individer med löparknäproblem kan ge en mer funktionell styrka och även större uthållighet. Denna träning kan också vara orsaken till att deras upplevelse av smärta och begränsning i aktivitet tenderade att minska.

A dor crônica de joelho secundária a osteoartrite é uma patologia comum com a progressão da idade e que vem aumentando sua prevalência a medida que se elevam a expectativa de vida e os índices de obesidade e sobrepeso. A consequência desses sintomas se reflete de maneira direta sobre a capacidade de realização de atividades diárias, a qualidade do sono e a capacidade laboral do indivíduo. O impacto psicológico, social e econômico da dor crônica de joelho representam um desafio de saúde pública, demandando tratamento eficiente e custo-efetivo. As terapias farmacológicas com frequência apresentam benefício limitado associado a diversos efeitos colaterais. Os procedimentos invasivos não cirúrgicos, como a injeção intraarticular de ácido hialurônico, representam uma alternativa em casos refratários ao tratamento clínico, sendo utilizados como terapia complementar, entretanto apresentam benefício limitado e insuficiente para o controle da dor em casos severos. Os procedimentos cirúrgicos, como a artroplastia total do joelho, habitualmente apresentam resultados satisfatórios na doença avançada, contudo são limitadas pelo seu alto custo, risco cirúrgico inerente e pequena capacidade resolutiva diante da alta prevalência. O bloqueio dos nervos geniculados é uma técnica recentemente descrita, de fácil realização e com mínima invasão necessitando ser estudada para que possa ser aplicada no manejo clínico. Neste estudo foram selecionados pacientes com osteoartrite moderada e severa, que apresentavam dor refratária ao tratamento clínico otimizado. Foram selecionados 16 pacientes e um total de 22 joelhos foram avaliados. Inicialmente todos os pacientes foram submetidos a um pré-teste que avaliava: 1) a intensidade da dor; 2) a qualidade do sono; 3) a capacidade de realização de atividades diárias. Aleatoriamente 2 grupos foram formados, o primeiro submetido ao bloqueio intra-articular e o segundo ao bloqueio dos nervos geniculados. A solução formada por: lidocaína 1% sem vasoconstrictor - 9 mL - 90 mg adicionada de Dexametasona - 1mL - 10 mg era padrão e utilizada nos dois grupos de intervenção. Após um seguimento semanal por 12 semanas consecutivas, os paciente foram reconvocados e submetidos ao outro procedimento proposto, dessa forma todos os pacientes atuaram como o seu próprio controle (desenho de estudo \"crossover\"). Nos seguimentos semanais, assim como no pré-teste, eram avaliados a intensidade da dor, a qualidade do sono e a capacidade de realização de atividades diárias. Os resultados mostraram que o bloqueio intra-articular e o bloqueio dos nervos geniculados apresentam redução importante da dor (p < 0,01), melhora na capacidade de realização de atividades diárias (p < 0,01) e melhora na qualidade do sono (p < 0,01), no entanto não houve diferença significativa no resultado entre os grupos estudados (p > 0,05). Conclui-se que o bloqueio dos nervos geniculados surge como uma alternativa segura, minimamente invasiva e de alta eficácia, apresentando resultados semelhantes ao bloqueio intra-articular. / Chronic pain of the knee secondary to osteoarthritis is a common pathology, progressive with age and which increases its prevalence as life expectancy is raised together with obesity and overweight. A consequence of these symptoms is reflected directly on the capacity of undertaking daily activities, the quality of sleep and the work capacity of each individual. The psychological, social and economic impact of chronic knee pain represents a challenge to public health, demanding efficient treatment at a worthwhile cost. Pharmaceutical therapies frequently present a limited benefit associated with various side effects. Non-surgical invasive procedures such as an injection intra-articular of hyaluronic acid, represents an alternative in refractory cases to clinical treatment, being used as a complementary therapy, however, presenting limited and insufficient benefit for the control of pain in severe cases. Surgical procedures such as complete arthroplasty of the knee, usually presents satisfactory results in patients with an advanced osteoarthritis, but are limited by their high cost, inherent surgical risk and small resolving capability facing a high prevalence. Blocking the genicular nerves is a recently described technique, easily applied by clinical management. Patients were selected in this study with moderate and severe osteoarthritis, with refractory pain in optimized clinical treatment. 16 patients were selected and a total of 22 knees were evaluated. Initially all the patients were submitted to a pre-test which evaluated: 1) the intensity of pain; 2) the quality of sleep; 3) the capacity to undertake daily activities. Two groups were formed randomly, the first submitted to intra-articular blocking and the second to blocking the genicular nerves. A solution of lidocaine 1% without a vasoconstrictor - 9 mL - 90 mg and Dexametasona - 1 mL - 10 mg was standard and used for intervention in both groups. After a weekly appraisal for 12 consecutive weeks, the patients were recalled and submitted to another proposed procedure and in this way all the patients acted as their own control (a \"crossover\" study design). In the following weeks, as also in the pretest, the intensity of pain, the quality of sleep and the capacity of undertaking daily activities were evaluated. The results showed that the intra-articular block and the blocking of the genicular nerves presented an important reduction of pain (p<0,01) but there was no significant difference in the result between the groups studied (p>0,05). It is therefore concluded that the blocking of the genicular nerves appears as a safe alternative, minimally invasive and highly efficient, presenting results similar to the intra-articular blocking.

No description available.

A common issue after injuries with or without surgery is muscular atrophy. Every year approximately 8000 individuals injure their ACL only in Sweden and 4000 undergo surgery. Rehabilitation usually consists of strength training and 70 % of 1RM is a preferred weightwhen trying to build strength and muscle. This systematic review and meta-analysis were investigating the effect of occlusion training after ACL injury compared to traditional rehabilitation, measured with knee function, muscle strength, pain and muscle mass. In this review PubMed, Cinahl, Sportsmedicine &amp; Education index, Cochrane Library, SportDiscus and Web of Science were used for the database search. Two independent authors performed the selection process, GRADE and risk of bias assessment. A total of nine studies were included for the synthesis where four could be included in the meta-analysis. No significant difference were found in the meta-analysis looking at muscle mass. No meta-analysis could be performed on knee function, muscle strength or knee pain. There was a significant difference in the intervention group performing occlusion training compared to the control group when looking at knee pain and knee function, but could not be verified bymeta-analysis. In conclusion occlusion training compared with traditional rehabilitation occlusion training seem to reduce experienced pain during training, increase knee function, preserve more muscle mass and give similar results in strength after 16 days to 16 weeks post ACLR.

Context: Knee pain is experienced by many people. Because of this, authors have started researching the effects of pain on lower extremity mechanics and also on static and dynamic postural control. However, the effects of pain are difficult to study due to associated confounding variables. Objective: We asked: (1) Will experimentally-induced anterior knee pain alter perceived pain using the visual analogue scale? ; (2) will perceived pain affect postural control as measured by center-of-pressure during static and dynamic movement? Design: Crossover. Setting: Biomechanics laboratory. Participants: Fifteen healthy subjects. Intervention: Each subject participated in single leg quiet stance, landing, and walking trials under three conditions (pain, sham, control), at three different times for each condition (pre-injection, injection, and post-injection). Main Outcome Measures: The dependent variables were measured at pre-injection, injection, and post-injection. Pain was measured using the visual analogue scale across all three times during each condition. Center-of-pressure sway was measured during single leg quiet stance to calculate the average center-of-pressure velocity in the anterior-posterior and medial-lateral directions. The center-of-pressure time to stabilization was measured in anterior-posterior, medial-lateral, and vertical directions, and center-of-pressure trajectory excursion was measured in the medial-lateral direction during walking. Results: Perceived pain was significant (P < 0.05) but did not affect postural control as measured by center-of-pressure medial-lateral and anterior-posterior sway during single leg quiet stance, in time to stabilization during landing, and in medial-lateral excursion during walking. Conclusions: Injection of hypertonic saline resulted in statistically significant perceived pain but did not affect postural control as measured by center-of-pressure medial-lateral and anterior-posterior sway during single leg quiet stance, in time to stabilization during landing, and medial-lateral excursion during walking.

Knee pain can alter lower-extremity neuromechanics and often results in functional disability. The relationship between lower-extremity neuromechanical alterations, due to anterior knee pain, and articular cartilage condition is unclear. The purpose of this study was to determine the independent effect of anterior knee pain during running on articular cartilage condition, as reflected by serum cartilage oligomeric matrix protein concentrations and muscle cocontraction duration. Seven men and five women completed a 30-min run in three different sessions: control (no infusion), sham (isotonic saline infusion), and pain (hypertonic saline infusion). Saline was infused into the right infrapatellar fat pad for the duration of the run. Subject-perceived pain was recorded every 3 min on a 100-mm visual analog scale. During the run, bilateral electromyography was recorded for five leg muscles, and heel and toe markers were used to track foot position. During the 30-min run of the pain session average subject-perceived pain was 27.8 (SD = 2.3 mm) and 19.7 (SD = 1.9) mm greater than during the control (0.0 mm) and sham (8.1 mm) session, respectively (p < 0.01). Knee pain while running did not result in changes in muscular cocontraction duration (p = 0.13). Blood samples were drawn prior to the run, immediately following the run, and 60 min following the run. Samples were analyzed using enzyme-linked immunosortbent assay to determine serum cartilage oligomeric matrix protein concentration. Average serum cartilage oligomeric matrix protein concentration was 14% greater at immediate post run (132.19 ± 158.61 ng/ml; Range = 22.61-290.81 ng/ml) relative to pre run (116.02 ± 118.87 ng/ml; Range = 19.81-234.89 ng/ml) (p < 0.01), and 18% less at 60 min post run (108.45 ± 171.78 ng/ml; Range = 20.84-280.23 ng/ml) relative to immediate post run (Figure 4; p < 0.01). Serum cartilage oligomeric matrix protein did not significantly differ between baseline and 60 min post-exercise (p = 0.29). There was not a difference in cartilage oligomeric matrix protein concentration between sessions. Knee pain while running does not cause an increase in serum cartilage oligomeric matrix protein concentration (p = 0.29). There are two important findings from this study. First, anterior knee pain during a 30 min running session does not appear to independently affect cartilage oligomeric matrix protein concentrations. This implies other factors, aside from anterior knee pain alone, influence articular cartilage degradation during movement that occurs while individuals are experiencing anterior knee pain. Second, the present experimental anterior knee pain model can be used to evaluate the independent effects of anterior knee pain over an extended duration while subjects perform a dynamic activity like running.

Abstract  Background One of the earliest signs of knee osteoarthritis (OA) is knee pain which correlates with inflammation and disease severity. Knee OA affects 260 million worldwide, and is in similarity with obesity, characterized by ongoing low-grade inflammation. The low grade-inflammation affects the knee-joint area and associations to cartilage degradation and bone remodelling have been shown. Most individuals, however, seek medical care for the first time when they experience knee pain. At this stage, the destruction of the knee is often irreversible. The inflammatory marker C-reactive can be found in both individuals who are obese and individuals with knee OA. It would be beneficial for the many individuals with knee pain at risk of developing knee OA, to be identified at an earlier stage and start treatment and hence slow down the progression of the disease.  Purpose  The purpose was to study associations between obesity, low-grade inflammation, self-reported knee symptoms and the outcome of radiographic knee OA in Swedish individuals with knee pain. Three research questions were formulated. Methods The design of this two-year longitudinal cohort study included Swedish individuals with present knee pain. Data was used to assess obesity and analyse inflammation to determine presence and/or severity of radiographic knee osteoarthritis and evaluate long- and short-term and symptoms and function of the knee. Original data were retrieved from the Cohort profile: the Halland osteoarthritis (HALLOA) cohort–from knee pain to osteoarthritis: a longitudinal observational study in Sweden. Individuals were recruited from healthcare clinics and newspaper advertisement. Age ranged from 32–63 and included data from 60 individuals after two years. Obesity was assessed where body composition was analysed with a bioelectrical impedance analysis. Level of C-reactive protein (CRP) was analysed with ELISA method. The outcome of radiographic knee OA was graded with Ahlbäck classification system in combination with physical examinations of the knees. Self-reported knee symptoms and function were measured with the questionnaire knee injury and osteoarthritis outcome score (KOOS). The data were analysed with the statistical computer software IBM SPSS Statistics.  Results No significant associations were found between the obesity, low-grade inflammation and the outcome of radiographic knee OA in Swedish individuals with knee pain. However, significant associations were found between the odds of developing radiographic knee OA assessed with KOOS for the subgroups pain (p = 0.032), symptom (p = 0.016), Sport/Rec (p = 0.02) and QOL (p = 0.038).  Conclusion KOOS questionnaire should be used for individuals with knee pain to identify individuals at risk of developing knee OA and ensue the disease progression, along with exercise and weight reduction if needed. CRP is not a good marker to measure inflammation in knee OA or use as a predictor tool.

Background Patients with patellofemoral pain (PFS) are common in primary health care. Young women are most affected, limiting them in everyday life and in sports. There is an increased risk of PFS in case of impaired strength and motor control in proximal musculature. Consensus prevails that therapeutic physical training should be included as part of rehabilitation, where the multimodal method is the golden standard. Purpose The aim is to evaluate the efficacy of tailored physiotherapy intervention involving motor control and strength training of proximal musculature combined with education with respect to pain, strength and function in patients with patellofemoral pain. Method A single subject experimental design study (SSED) consisting of three young women with PFS was conducted. The design is an A-B design, which includes a baseline phase with repeated measurements (A) and an intervention phase with tailored physiotherapy (B). The primary outcome measures were estimated with a visual analog scale (VAS) as well as strength measurement of proximal musculature with a handheld dynamometer (HHD). The secondary outcome measure was self-perceived function, estimated with Patient Specific Functional Scale (PSFS). Results The results of this SSED show that tailored physiotherapy intervention involving motor control and strength training of proximal musculature combined with education can be effective for young women with PFS. The results are not entirely consistent in terms of pain, strenght and self-perceived function where one in three participants showed significant (alpha 0.05) reduced pain and two out of three participants showed significant (alpha 0.05) improvement of self-perceived function. Regarding strength, there was no significant (alpha 0.05) effect on the affected side of any of the participants:  Conclusion Motor control and strength training of proximal musculature combined with education may be effective for young women with PFS with respect to pain and self-perceived function.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24097号 / 人健博第104号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

A Síndrome da Dor Anterior no Joelho (SDAJ) caracteriza-se por uma dor difusa retropatelar e peripatelar na articulação do joelho, exacerbada por atividades de sobrecarga sobre a articulação femoropatelar. Muitos estudos têm sido realizados no sentido de compreender os mecanismos causadores da SDAJ e suas consequências. Entre os aspectos pesquisados encontram-se a ativação muscular, relação de ativação e de capacidade de geração de força entre os músculos vasto medial e vasto lateral, a força quadriciptal e dos músculos do quadril, e as alterações mecânicas do membro inferior. Segundo a literatura, um dos principais fatores de risco para o desenvolvimento dessa patologia é a fraqueza dos extensores do joelho. A fraqueza dos extensores do joelho pode estar associada à inibição muscular (IM) que o músculo quadríceps femoral sofre em função dos estímulos dolorosos. Esta alteração na geração de força e na capacidade de ativação muscular parecem alterar a morfologia do quadríceps e influenciar as alterações mecânicas ao nível da articulação femoropatelar. Para o melhor do nosso conhecimento, não foi encontrado na literatura nenhum estudo sistemático que investigasse simultaneamente os diversos aspectos da SDAJ, tentando assim estabelecer uma relação entre os aspectos morfológicos, mecânicos e elétricos dos extensores do joelho com a SDAJ. O presente estudo tem por objetivo comparar as propriedades mecânicas, morfológicas e mioelétricas dos extensores do joelho entre sujeitos acometidos pela SDAJ e um grupo controle saudável (GC). Nossa hipótese era de que os pacientes com SDAJ apresentarão uma redução nas propriedades mecânicas, morfológicas e mioelétricas dos extensores do joelho em decorrência da inibição muscular (IM) crônica produzida pela síndrome. Além disso, o estudo também tem por objetivo avaliar se existe diferença na metodologia de aplicação da técnica de interpolação de abalo para avaliação da IM do quadríceps a partir da comparação do uso de estímulos elétricos supramáximos sobre o nervo femoral (padrão ouro) com a estimulação sobre o ponto motor (nova metodologia) em sujeitos saudáveis e indivíduos com SDAJ. Nossa hipótese era de que a estimulação sobre o ponto motor será menos desconfortável que sobre o nervo femoral e os resultados de IM serão menos variáveis (com uma menor dispersão) em função desse menor desconforto. No Capítulo I, foi realizado um levantamento da literatura sobre as variáveis que foram avaliadas no decorrer do estudo, buscando informar ao leitor o que já foi feito na área, as lacunas e contradições acerca da SDAJ. No Capítulo II, foi realizado um estudo transversal sobre a avaliação da IM do quadríceps femoral, a partir da Técnica de Interpolação de Abalo (ITT), com a aplicação do abalo sobre o nervo femoral (NF) e sobre o ponto motor (PM). Vinte e nove sujeitos do sexo feminino, com idade entre 20 e 40 anos, sintomáticas (SDAJ, n=16) e assintomáticas (GC, n=13) para SDAJ, foram submetidas a avaliação da IM sobre o PM e NF no ângulo de 60° de flexão do joelho (0°=extensão máxima). Os resultados demonstraram que, para o grupo SDAJ, o PM apresenta resultados inferiores de IM comparado ao NF; já para o GC, os resultados foram semelhantes entre os dois pontos de estimulação. No Capítulo III foram realizadas avaliações da capacidade funcional, da IM e das propriedades mecânicas, morfológicas e mioelétricas dos extensores do joelho. Trinta e duas mulheres, com idade entre 20 e 40 anos, sintomáticas (SDAJ, n=16) e assintomáticas (GC, n=16) para SDAJ, foram avaliadas. Os resultados apontam para uma maior IM e reduções na capacidade funcional, no torque isométrico, na espessura da cartilagem femoropatelar e na arquitetura muscular do grupo SDAJ em relação ao GC. A revisão de literatura realizada no Capítulo I demonstrou que a literatura apresenta divergências sobre as alterações neuromecânicas decorrentes da SDAJ em mulheres. Os resultados do Capítulo II indicam que a avaliação da IM por meio da ITT é melhor tolerada por mulheres jovens sintomáticas para SDAJ quando avaliada no NF em comparação ao PM. Já no Capítulo III foram observados maiores valores de IM e reduções na capacidade funcional, torque isométrico, espessura da cartilagem femoropatelar e arquitetura muscular nos sujeitos com SDAJ em comparação ao GC saudável. / The Anterior Knee Pain (AKP) syndrome is characterized by retropatellar and peripatellar diffuse pain in the knee joint, exacerbated by overloading activities on the patellofemoral joint. Many studies have been carried out to understand the causal mechanisms of AKP and its consequences. Among the researched aspects are muscle activation, relationship of activation and capacity of strength generation between the vastus medialis and the vastus lateralis muscles, the strength of quadriceps and hip muscles, and mechanical changes of the lower limb. According to the literature, one of the main risk factors for the development of this pathology is the knee extensors weakness. This knee extensors weakness might be associated with the muscle inhibition (MI) that the femoral quadriceps muscle suffers as a result of painful stimuli. These changes in strength generation and muscle activation capacity appear to change the quadriceps morphology and influence mechanical changes at the patellofemoral joint level. To the best of our knowledge, there is no systematic study in the literature that simultaneously investigated the various aspects of AKP, trying to establish a relationship between the morphological, mechanical and electrical aspects of the knee extensors in subjects with AKP. This study aimed to compare the knee extensors mechanical, morphological and myoelectric properties between subjects affected by AKP and a control group (CG). Our hypothesis was that patients with AKP should present a reduction in the knee extensors mechanical, morphological and myoelectric properties due to chronic muscle inhibition (MI) produced by the syndrome. In addition, the study also aimed to evaluate whether there are differences in methodology for application of the interpolated twitch technique for evaluation of the quadriceps MI by comparing the use of supramaximal electrical stimulation on the femoral nerve (gold standard) with stimulation on the motor point (new methodology) in healthy subjects and subjects affected by AKP. Our hypothesis was that the stimulation on the motor point should be less uncomfortable than on the femoral nerve and MI results should be less variable (with lower dispersion) due to such lower discomfort. In Chapter I, a literature review on the variables that were evaluated throughout the study was carried out, seeking to inform the reader on what has already been done in the area, on gaps and contradictions regarding AKP. Chapter II presents a transversal study on the assessment of the quadriceps MI with the use of the Interpolated Twitch Technique (ITT), with application of twitch on the femoral nerve (FN) and on the motor point (MP). Twenty-nine women, aged between 20 and 40 years, symptomatic (AKP, n=16) and asymptomatic (CG, n=13) for AKP, were subjected to evaluation of MI on the MP and FN at an angle of 60° of knee flexion (0°=fully extended). Results showed that, for the AKP group, MP has inferior results of MI when compared to FN; results are similar between the two stimulation points for the CG. In Chapter III, evaluations of functional capacity, MI and knee extensors mechanical, morphological and myoelectric properties were carried out. Thirty-two women, aged between 20 and 40 years, symptomatic (AKP, n =16) and asymptomatic (CG, n =16) for AKP were evaluated. Results indicated greater MI and reductions in functional capacity, in isometric torque, in patellofemoral cartilage thickness and in muscle architecture in the AKP group compared to CG. Results from literature review conducted in Chapter I showed disagreement about neuromechanics changes resulting from SDAJ in women. Chapter II results indicated that the evaluation of IM through ITT is better tolerated by young women symptomatic for SDAJ when evaluated in the NF compared to the PM. Chapter III showed higher MI values and reductions in functional capacity, isometric torque, patellofemoral cartilage thickness and muscle architecture in subjects with SDAJ compared to a healthy GC.