Lower extremity injuries are the most common sports related injury. Many steps have been taken to attempt to identify individuals who might be at a higher risk for sustaining a lower extremity injury. Resource and time intensive screening techniques have been used previously to attempt to identify such individuals. However these techniques have focused heavily on postural control and landing mechanics in athletes, no psychological measure has been used to identify individuals who might be at a higher risk of lower extremity injury. Self-efficacy of balance can be defined as how capable an individual feels he or she can balance in different scenarios. Research in the balance deficient population (elderly, post-stroke, knee osteoarthritis) has revealed that selfefficacy of balance is a quantifiable psychological component of balance related behavior. As previously stated, current screening techniques for lower extremity injuries do not incorporate psychological measures. Research suggests that psychological indicators of balance confidence are important to measure in conjunction with balance test performance to establish the relationship between the two constructs. Assessment of these factors is necessary to examine how psychological measures affect performance on tests used in clinical balance assessments. The objective of this dissertation was to develop the Self-Efficacy of Balance Scale (SEBS), a psychometrically sound self-efficacy of balance instrument for use in the young, active population. The relationship between selfefficacy of balance and self-reported measures of lower extremity function, and clinical and laboratory measures of balance were also examined in the young, active population. It was hypothesized that a valid, reliable, responsive tool could be created to accurately and precisely measure self-efficacy of balance in a young, active population. It addition, it was hypothesized that high levels of selfefficacy of balance would have a significant, positive relationship with selfreported measure of lower extremity function, and clinical and laboratory measure of balance. Results from the three studies brought about several interesting observations. Studies one, two, and three demonstrated evidence of a psychometrically sound instrument. This indicates that the SEBS is a valid, reliable, responsive self-efficacy of balance instrument when evaluating young, active individuals. Study three demonstrated the relationships between selfefficacy of balance and self-reported measures of function, and objective measures of balance. These relationships revealed that while lower extremity function and some measures of balance influence scores of the SEBS, they do not account for all of the variability of the SEBS. This finding further supports the claim that balance behavior is changing as function and postural control change. Therefore, future research should include investigation regarding the utility of the SEBS, as well as longitudinal studies to establish effectiveness of identifying individuals at a higher risk of sustaining a lower extremity injury.

Title: Electromyographic analysis of selected muscles of lower extremity of kitesurfers. Objective: The goal of thesis is to determine muscle groups, which are the most active during the kitesurfing position and compare the values in increasing time spent in this position. Furthermore, to determine a degree of co-contraction level between m. quadriceps femoris and m. biceps femoris. According to the enlarging number of riders in kitesurfing population the goal is to compare results between professional and recreant riders and determine statisticaly significant differences. Methods: This thesis is a case study, where is analyzed the degree of muscle aktivity of lower extremity during the kitesurfing position. The research involved 6 persons of very specific selection consisted of professional riders and recreants. As an objectification method surface electromyography had been chosen and the normalized value between m. quadriceps femoris, m. gluteus maximus, m. biceps femoris, m. tibialis anterior, m. gastrocnemius and m. trapezius had been evaluated. Findings: The measurement results showed that the most active muscle during the kitesurfing position is m. quadriceps femoris of stance lower extremity even though after long-term stay. Furthemore, the results showed that professional riders apply more...

Contexto: Existem controvérsias na literatura médica sobre potenciais alterações da hemodinâmica venosa dos membros inferiores durante a gravidez. Objetivo: Estudar a drenagem venosa em membros inferiores e suas alterações na gestação (1º, 2º e 3º trimestres) e pós-parto mediante Mapeamento Dúplex (MD) das veias profundas e superficiais e a Pletismografia a Ar (PGA). População: Foram recrutadas vinte mulheres primigestas, sem doença venosa prévia, junto aos Núcleos de Saúde da Família ligados ao Centro de Saúde Escola da FMRP-USP. Métodos: O estudo hemodinâmico venoso nos membros inferiores foi realizado empregando-se dois métodos não invasivos: o MD e a PGA. Foram registrados os diâmetros e os refluxos das principais veias (femoral comum, femoral, poplítea, safena magna e parva) dos membros inferiores por meio do MD. Foram avaliados pela PGA: o índice de enchimento venoso (IEV), a fração de ejeção (FE), a fração de volume residual (FVR) e o esvaziamento venoso (OF-outflow). Todos os registros foram obtidos em 3 diferentes períodos da gestação e no pós-parto. Os dados foram estatisticamente analisados e considerou-se p?0,05. Resultados: Houve aumento do diâmetro venoso no território da femoral comum e da safena magna infravalvar bilateralmente, nos 2º e 3º trimestres. Na PGA, registrou-se diminuição da FVR bilateral, elevação do IEV à direita e aumento do OF bilateral no decorrer da gestação. Observou-se edema em 4 (15%) gestantes no segundo trimestre e 11 (55%) no terceiro trimestre. Quanto ao refluxo, documentouse um caso no 2º trimestre no território da safena magna supravalvar esquerda (5%) e mais dois casos no 3º trimestre (15%), sendo uma no território da safena magna infravalvar esquerda e outra gestante com refluxo nos territórios de safena magna infravalvar e safena parva esquerdas. Após o parto, houve regressão de todas essas alterações anatômicas e hemodinâmicas da drenagem venosa dos membros inferiores. Conclusão: Apesar do aumento significativo dos diâmetros das veias femorais comuns e safenas magnas infravalvares bilateralmente, diminuição da FVR bilateral, elevação do IEV à direita, aumento do OF durante a gestação, todas essas alterações retornaram aos parâmetros anatômicos e hemodinâmicos venosos iniciais, após o parto / Background: The relation between pregnancy and venous reflux is still misunderstood and some authors question if pregnancy is the main cause of venous reflux and venous disease. Objective: analyze venous hemodynamics in healthy primigravidae during the first, second and third trimester of pregnancy and in the puerperium. Methods: prospective study with 20 primigravidae evaluated in the first, second and third trimester of pregnancy and postpartum. Duplex scan evaluated venous diameters and reflux; air plethysmography evaluated venous filling index (VFI), ejection fraction (EF), residual volume fraction (RVF), outflow fraction (OF )in both limbs. OF in the right limb while the patient was in left lateral decubitus position was also evaluated. Results: During pregnancy, there was bilateral increase in venous diameters in common femoral and infravalvar great saphenous veins; occurrence of reflux in the left surpravalvar great saphenous vein in one patient (5%) in the second trimester; and occurrence of reflux more other two patents (15%) in the third trimester: one in the left infravalvar great saphenous vein, and other in the left popliteal and small saphenous vein. All these alterations observed during pregnancy disappeared after delivery. VFI decreased after delivery in the left limb, but increased progressively in the right limb, returning to basal level after delivery; EF did not change; RVF decreased during pregnancy, mainly in left limb, and returned to basal level after delivery; OF increased during pregnancy and returned to basal levels after delivery; OF in left lateral decubitus did not change. Conclusion: pregnancy caused a diameter increase in bilateral common femoral and great saphenous veins, unilateral right increase in VFI, bilateral decrease in the RVF and bilateral increase in OF. All these parameters returned to initial status after delivery

Estudo quantitativo, descritivo e retrospectivo de internações hospitalares de pacientes com e sem o diagnóstico de diabetes submetidos a amputação não traumática de extremidades inferiores, no período de 2001 a 2008, em Ribeirão Preto - SP - Brasil. Este estudo teve como objetivos caracterizar as internações hospitalares de pacientes com e sem o diagnóstico de diabetes mellitus submetidos a amputação não traumática de extremidades inferiores segundo sexo, idade, período da internação hospitalar, tipo de atendimento e condições da alta; relacionar as internações hospitalares com as variáveis tipo de alta e atendimento, sexo, idade e tempo de internação, e analisar a tendência das internações hospitalares em Ribeirão Preto-SP, no período de 2001-2008. Utilizaram-se dados de fonte secundária de internações hospitalares, do Sistema de Informações do Centro de Processamento de Dados Hospitalares. Os resultados mostraram que das 2296 internações hospitalares relacionadas ao procedimento de amputação não traumática de extremidades inferiores, 954 (41,6%) tinham o diagnóstico de diabetes mellitus. A maioria (58,7%) é do sexo masculino; idade média de 63,9 anos; 54,8% residiam em Ribeirão Preto-SP e 72,6% receberam assistência hospitalar pelo Sistema Único de Saúde. O tempo de internação hospitalar variou de 0 a 128 dias, média de 9,9 dias. A taxa de reinternações foi de 12,7% e de óbito 7,9%. A tendência de internações hospitalares não obedece a um padrão regular e o modelo de regressão linear ajustado para verificar a existência de tendência não mostrou significância estatística. O teste Qui-quadrado apresentou significância estatística, p-valor < 0,001, para variável sexo e o teste de Mann-Whitney mostrou significância estatística p-valor <0,001 para o tempo de internação hospitalar. Esses resultados apontam a importância de reforçar as ações de educação aos pacientes com diabetes mellitus com vistas à prevenção de amputações como desfecho da doença / Quantitative, descriptive and retrospective study of hospital admissions of patients with and without a diagnosis of diabetes mellitus undergoing non-traumatic amputation of the lower extremities, in the period from 2001 to 2008 in Ribeirão Preto - SP - Brazil. This study aimed to characterize the hospital admissions of patients with and without a diagnosis of diabetes undergoing non-traumatic amputation of lower extremities by sex, age, hospitalization time, type of care and discharge conditions; relate the hospitalizations with the variable type of discharge and attendance, sex, age and hospitalization time and analyze the tendency of hospital admissions in Ribeirão Preto-SP, in the period from 2001 to 2008. Source of data were used secondary hospitalizations, from the National Hospital Data Processing Center Information. Of 2296 hospital admissions related to non-traumatic amputation procedure of the lower extremities, 954 (41.6%) had a diagnosis of diabetes mellitus, most (58.7%) were male, mean age 63.9 years. 54.8% live in Ribeirão Preto-SP, 72.6% received hospital care by SUS, hospital stay ranging from 0 to 128 days, an average of 9.9 days. The readmission rate was 12.7% and 7.9% died. The trend of hospitalizations did not follow a regular pattern and the linear regression model adjusted to check the trend was not statistically significant.The chi-square test was statistically significant, p <0.001, for gender variable and the Mann-Whitney test revealed statistically significant p-value <0.001 for the variable hospital stay. These results show the importance of strengthening education activities to patients with diabetes in order to prevent amputations as the outcome of the disease

O primeiro arabesque é uma pose elementar do ballet clássico e para realiza-la, a bailarina precisa dominar quesitos técnicos que incluem: a manutenção do turnout, o posicionamento do pé de apoio (em meia-ponta ou em ponta), a utlização de sapatilhas específicas e as estratégias de inicação do movimento (arabesque relevé ou arabesque piqué). Assim, o proposito deste estudo foi descrever, avaliar e comparar os padrões cinéticos e cinemáticos do membro inferior da bailarina durante a execução do primeiro arabesque realizado com os quesitos técnicos acima descritos a fim de entender as diferenças e similaridades entre os quesitos avaliados. A amostra foi composta por 26 bailarinas com 13,5±5.02 anos de ballet clássico, as quais realizaram o arabesque piqué e relevé, com sapatilhas de ponta e meiaponta de forma aleatorizada, acompanhados por uma cadência musical adequada. Foram adquiridos: a componente vertical da força reação do solo (FRS) e do centro de pressão (COP), a variação angular das articulações do joelho e tornozelo nos planos sagital, frontal e transversal, além dos momentos articulares sagitais de joelho e tornozelo calculados por dinâmica inversa. As comparações inter-condições foram realizadas por ANOVAs dois fatores [estratégia de iniciação (2) x sapatilha(2)]. A avaliação da componente vertical da FRS mostrou efeito de interação entre sapatilhas e estratégias de iniciação, além de efeitos isolados no aumento da FRS vertical para o arabesque relevé. A avaliação do comportamento do COP mostrou efeito de interação entre todas as variáveis, novamente apontando maiores oscilações em relação ao arabesque relevé. As diferentes sapatilhas não modificaram o comportamento angular e nem o momento articular resultante de joelho e tornozelo, revelando que a estratégia de iniciação é fator determinante no resultado biomecânico final do arabesque / The first arabesque is an elementary pose of classical ballet. To perform it, the dancer needs to lead with technical questions that include: the maintenance of the turnout, the positioning of the support foot (pointe or half-pointe), the iniciation movement strategies (piqué or relevé arabesque). Thus, the purpose of this study was to describe, evaluate and compare the kinetic and kinematic patterns of the lower limb of the dancer during the execution of the first arabesque performed with the technical questions described above in order to understand the differences and similarities between the evaluated items. The sample consisted of 26 dancers with 13.5 ± 5.02 years of classical ballet, who performed the piqué and relevé arabesque, with slippers or pointe shoes, in randomized trails, accompanied by a suitable musical cadence. Were evaluated: the vertical component of the ground reaction force (FRS), the center of pressure distribution (COP), the angular variation of the knee and ankle joints in the sagittal, frontal and transverse planes, and the sagittal knee and ankle joint loads (inverse dynamics). The inter-condition comparisons were performed by ANOVAs two factors [initiation strategy (2) x ballet shoes (2)]. The evaluation of the vertical component of FRS showed an interaction effect between shoes and initiation strategies, as well as isolated effects in the increase of vertical FRS for arabesque relevé. The evaluation of the behavior of the COP showed an interaction effect among all variables, again pointing to greater oscillations in relation to the arabesque relevé. The different ballet shoes (pointe shoe or slipper) did not modify the angular behavior nor the knee and ankle joint loads, revealing that the initiation strategy is a determining factor in the final arabesque biomechanical result

INTRODUÇÃO: A reconstrução de defeitos de partes moles da região plantar representa grande desafio à Cirurgia Plástica. Há controvérsias com relação ao tipo de tecido ideal a ser empregado: se muscular ou cutâneo. OBJETIVO: O presente estudo pretende avaliar os resultados da reconstrução e reabilitação de pacientes portadores de defeitos complexos da região plantar por meio da utilização de retalho composto, muscular e cutâneo, proveniente da região anterolateral da coxa. MÉTODOS: No período de julho 2009 a julho 2011, 25 pacientes portadores de defeitos plantares e com idades variando de 19 a 76 (média: 57,1 anos), sendo 14 do sexo masculino e 11 do sexo feminino, foram tratados no Hospital das Clínicas da FMUSP. Dos 25 pacientes, 22 apresentavam defeitos resultantes de ressecções de melanoma e 3, perdas decorrentes de traumatismo do membro inferior. A neurorrafia entre o nervo cutâneo femoral lateral, presente no retalho anterolateral, e o ramo calcâneo presente no defeito na região plantar foi realizado em 7 pacientes. O período médio de seguimento foi de 12 meses. RESULTADOS: O componente muscular de todos (100%) os retalhos manteve-se viável. Com relação ao componente cutâneo, houve 2 casos de perda parcial e 1 caso de perda total. Após 4 semanas de pós-operatório, o contorno foi considerado bom em 19 casos; a estabilidade adequada em 23 casos e a deambulação satisfatória em 22 casos. Os 7 retalhos submetidos à reinervação recuperaram grau de sensibilidade cutânea inferior ao do local de origem. CONCLUSÕES: O retalho proposto foi adequado para a reconstrução dos defeitos da região plantar. Observou-se baixa incidência de complicações locais. A qualidade do contorno, estabilidade ou deambulação foi considerada adequada na maioria dos casos. Não se verificou vantagem dos retalhos inervados sobre os não inervados / INTRODUCTION: Reconstruction of soft tissue defects of the plantar region represents a major challenge in plastic surgery. There is controversy regarding the ideal type of tissue to be used: muscle or skin. OBJECTIVE: This study aims to evaluate the results of the reconstruction and rehabilitation of patients with complex defects of the plantar region by using a composite flap of muscle and skin from the anterolateral thigh. METHODS: From july 2009 to july 2011, 25 patients with plantar defects and aged 19-76 (mean: 57.1 years), 14 males and 11 females, were treated at Hospital das Clinicas. Twenty-two patients had defects resulting from resection of melanoma and 3 losses resulting from trauma of the lower limb. Neurorrhaphy between the lateral femoral cutaneous nerve, present in the anterolateral flap, and the calcaneal branch defect, present in the plantar region, was performed in 7 patients. The mean follow-up was 24 months. RESULTS: The muscular component of all (100%) flaps remained viable. There were 2 cases of partial loss and 1 case of total loss of the cutaneous component. At 4 weeks postoperatively, the contour was considered good in 19 cases; stability adequate in 23 cases and ambulation satisfactory in 22 cases. The 7 flaps submitted to reinnervation recovered less skin sensitivity in comparison with the donor site. CONCLUSIONS: The proposed flap is suitable for reconstruction of defects in the plantar region. Few local complications were observed. The quality of the contour, stability and ambulation were considered adequate in most cases. No advantage was found for the innervated over the non-innervated flap

INTRODUÇÃO: Os ferimentos descolantes nos membros inferiores frequentemente se apresentam como lesões graves. Há dificuldade na decisão sobre o tratamento mais adequado, o reposicionamento e sutura do retalho ou o emagrecimento e enxertia da pele avulsionada. Este estudo avaliou os pacientes com ferimentos descolantes nos membros inferiores, analisando o perfil epidemiológico e a evolução dos pacientes de acordo com o tratamento realizado. Após a análise dos dados e a revisão da literatura, propõe-se um protocolo para padronização do atendimento. MÉTODOS: Foram avaliados retrospectivamente 42 pacientes vitimas de ferimentos descolantes em membros inferiores atendidos no HC-FMUSP entre julho de 2003 e junho de 2007. Os pacientes foram divididos de acordo com o tratamento em 2 grupos: grupo 1 (n = 21; reposicionamento do retalho) e grupo 2 (n = 21; ressecção do retalho e enxertia imediata). Os pacientes do grupo 1 foram atendidos inicialmente em outros serviços e referenciados ao HC-FMUSP com mais de 24 horas após o trauma (16 pacientes) ou foram atendidos pela cirurgia do trauma do HC-FMUSP (5 pacientes) sem a participação da cirurgia plástica nas primeiras 24 horas. Os pacientes do grupo 1 foram tratados com limpeza, reposicionamento e sutura do retalho avulsionado à posição original. Os pacientes do grupo 2 tiveram como tratamento limpeza e desbridamento da ferida, ressecção do retalho avulsionado e emagrecimento do retalho até a espessura de pele e enxertia desta pele no atendimento inicial. RESULTADOS: Dezenove pacientes do grupo 1 (90%) apresentaram necrose e perda total do retalho reposicionado, necessitando tratamento adicional com desbridamento da necrose e enxertia de pele. Dois pacientes (10%) do grupo 1 tiveram evolução favorável, não necessitando de tratamento adicional. Os pacientes dos grupos 1 e 2 apresentaram dados estatisticamente similares em relação à enxertia de pele (G1 = 81%; G2 = 86%; p > 0,999), enxertia de pele complementar (G1 = 48%; G2 = 71%; p = 0,208), cobertura com retalho cirúrgico (G1 = 14%; G2 = 19%; p > 0,999), complicações clínicas (G1 = 33%; G2 = 24%; p = 0,734), complicações cirúrgicas (G1 = 14%; G2 = 33%; p = 0,277), taxa de amputação (G1 = 10%; G2 = 29%; p = 0,238) e taxa de óbito (G1 = 0; G2 = 14%; p = 0,232). Houve diferença estaticamente significativa no tempo de internação, com os pacientes do grupo 1 permanecendo mais tempo internados (G1 = 46,2 dias; G2 = 32,5 dias; p < 0,001). CONCLUSÕES: Houve alto índice de necrose do retalho avulsionado ! nos pacientes que receberam o tratamento de reposicionamento e sutura do retalho ao leito de origem (90%; grupo 1). O tratamento de ressecção do retalho avulsionado, emagrecimento até a espessura de pele e enxertia imediata (grupo 2) proporcionou melhor evolução com relação ao tempo de permanência hospitalar. / INTRODUCTION: Lower extremity degloving injuries are often characterized as serious injuries. There is difficulty in deciding on the most appropriate treatment, whether flap repositioning and suturing or converting the avulsed flap to split-thickness skin grafting. This study assessed patients with degloving injuries in lower extremities, reviewing the epidemiological profile and patient outcome related to the performed treatment. After data analyzing and literature reviewing, a treatment protocol is proposed for standardization of care. METHODS: Forty-two patients were retrospectively evaluated, grouped in 2 groups according with the treatment performed: group 1 (n = 21; flap repositioning) and group 2 (n = 21; flap resection and skin grafting). Group 1 was cared initially in other hospitals (16 patients) or by trauma surgery team in our hospital (5 patients) and it had treatment with washing, repositioning and suturing of avulsed flap to the original position. Group 2 had treatment with washing, debridement, resection of avulsed flap and converting the flap to split-thickness graft in the first care. RESULTS: Nineteen patients in the group 1 (90%) followed necrosis and total flap loss. These patients had additional surgery for skin grafting. Patients of groups 1 and 2 had similar finds with relation to skin grafting (G1 = 81%; G2 = 86%; p > 0,999), complementary skin grafting (G1 = 48%; G2 = 71%; p = 0,208), surgical flap (G1 = 14%; G2 = 19%; p > 0,999), clinical complications (G1 = 33%; G2 = 24%; p = 0,734), surgical complications (G1 = 14%; G2 = 33%; p = 0,277), amputation rate (G1 = 10%; G2 = 29%; p = 0,238) and death rate (G1 = 0; G2 = 14%; p = 0,232). There was statistical significant difference in length of hospital stay, with patients of group 1 staying longer inhospital (G1 = 46,2 days; G2 = 32,5 days; p < 0,001). CONCLUSIONS: There was high rate of flap necrosis in group 1 (90%) that had repositioning and suturing of avulsed flap. Group 2, with resection, defatting and immediate skin grafting, had better outcome in relation to inhospital stay.

Introdução: O alongamento é um recurso bastante presente em estratégias que visem à prevenção da flexibilidade e/ou reabilitação, e tem sido preconizado como sendo importante componente do exercício físico. Diversos estudos têm mostrado a eficácia de diferentes técnicas, porém não há unanimidade em estudos de efeito crônico no que diz respeito à técnica mais eficiente, bem como sua relação com a força muscular. Com isso o objetivo deste estudo foi comparar o efeito de duas formas distintas de alongamento sobre aspectos musculoesqueléticos dos isquiotibiais de mulheres jovens. Métodos: Este estudo é um ensaio clínico randomizado. A amostra foi composta por 18 mulheres jovens divididas em três grupos: (GCon) grupo controle (n= 6; 24,0±2,8 anos); (GEst) grupo que realizou alongamento estático passivo (n= 6; 23,3±2,2 anos) e (GFnp) grupo que realizou alongamento de facilitação neuromuscular proprioceptiva (n= 6; 24,6±2,6 anos). A avaliação do torque muscular, flexibilidade, ativação elétrica e arquitetura muscular foi realizada uma semana antes do início do treinamento e a reavaliação, uma semana após o término. Para a avaliação do torque muscular dos flexores e extensores do joelho foi utilizado um dinamômetro isocinético. A avaliação da flexibilidade foi composta pelos testes de Elevação do Membro Inferior Estendido (EXT) e de Extensão de Joelho Modificado (TEJ) onde a amplitude de movimento (ADM) foi mensurada através de um goniômetro universal. A avaliação da ativação elétrica do vasto lateral, reto femoral e bíceps femoral foi realizada simultaneamente ao teste de força muscular e flexibilidade utilizando-se um eletromiógrafo. A arquitetura muscular foi avaliada através da ultrassonografia. O treinamento consistiu de um programa de quatro semanas de alongamento com três sessões semanais. Cada sessão era composta por uma repetição de alongamento, estático (30s) ou FNP (6s de contração máxima seguido por 30s de alongamento). O GCon não realizou treinamento. Para análise estatística foi utilizada uma ANOVA de dois fatores para a comparação entre os grupos e entre momentos seguida de um posthoc de Bonferroni. Para análise foi utilizado o software SPSS 20.0 e o nível de significância adotado foi α de 0,05. Resultados: A ADM mensurada pelo teste EXT apresentou aumento significativo entre os momentos pré e pós do GEst (pré= 80,8º±11,0 e pós= 94,5º±10,2; p= 0,013), não havendo diferenças entre os grupos (p>0,05); também houve diferença no torque concêntrico dos flexores de joelhos nos três grupos quanto ao momento, GEst (pré= 66,3Nm±12,9 e pós= 70,0Nm±8,1; p=0,023), GFnp (pré= 79,1Nm±12,7 e pós= 83,5Nm±11,6; p=0,014) e Gcon (pré= 71,1Nm±10,1 e pós= 74,1Nm±14,6; p=0,003), porém não houve diferença entre os grupos. A contração excêntrica desse grupo muscular não apresentou diferença significativa intra e inter grupos, assim como a espessura e a ativação elétrica muscular (p>0,05). Conclusão: Não houve diferença entre os grupos, porém o protocolo de alongamento estático passivo proposto propiciou um aumento da ADM e do torque da musculatura isquiotibial, sem influência na espessura muscular e ativação elétrica, dados que sugerem ser o ganho de ADM decorrente do aumento da tolerância do indivíduo ao alongamento do que decorrente de mudanças na estrutura muscular. / Introduction: Stretching is a very present action strategies aimed at prevention of flexibility and/or rehabilitation, and has been recommended as an important component of exercise. Several studies have shown the effectiveness of different techniques, but there is no unanimity in chronic effect studies as regards the most efficient technique, as well as its relationship with muscular strength. Thus the aim of this study was to compare the effect of two different forms of stretching on musculoskeletal aspects of the hamstrings of young women. Methods: This study is a randomized clinical trial. The sample consisted of 18 young women divided into three groups: (GCon) control group (n= 6; 24.0±2.8 years); (GEst) group performed passive static stretching (n= 6; 23.3±2.2 years) and (GFnp) group performed proprioceptive neuromuscular facilitation stretching (n= 6; 24.6±2.6 years). Evaluation of muscular torque, flexibility, muscle activation and muscle architecture was evaluated a week before the start of training and reevaluated, a week after the end. For the evaluation of knee flexors and extensors muscular torque was used an isokinetic dynamometer. The flexibility assessment was made by Single Leg Raise Test (SLR) and Modified Knee Extension Test (KET) where the range of motion (ROM) was measured using a goniometer. The evaluation of the electrical activation of the vastus lateralis, rectus femoris and biceps femoris was held simultaneously with the muscle strength test and flexibility using a electromyography. Muscle architecture was assessed by ultrasonography. The training consisted of a four weeks program of stretching with three weekly sessions. Each session consisted of a single stretching repetition, static (30s) or PNF (6s maximum contraction followed by 30 seconds elongation). The GCon not trained. Statistical analysis was performed using a two-way ANOVA for comparison between groups and between moments followed by post-hoc Bonferroni test. For analysis was used SPSS 20.0 and the level of significance was α of 0.05. Results: ROM measured by SLR test showed a significant increase between pre and post GEst (pre= 80.8º±11.0 and post= 94.5º±10.5; p= 0.013), with no differences between the groups (p> 0.05); also was difference between pre and post training in concentric torque of the knee flexors in the three groups, GEst (pre= 66.3Nm±12.9 and post= 70.0Nm±8.1; p= 0.023), GFnp (pre= 79.1Nm±12.7 and post= 83.5Nm±11.6; p= 0.014) and GCon (pre= 71.1Nm±10.1 and post= 74.1Nm±14.6; p= 0.003), but there was no difference between groups. The eccentric contraction of this muscle group showed no significant difference intra and inter groups, as well as the thickness and muscle electrical activation (p>0.05). Conclusion: There was no difference between the groups but the proposed passive static stretching protocol provided an increase in ROM and torque of the hamstring muscles, but no effects on muscle thickness and electrical activation, data that suggest the gain of ROM occurred due to the increase of the individual's tolerance to stretching, and not from changes in muscle structure.

Part 1. Characteristics of foot movement in Tai Chi exercise. The performance of 16 experienced Tai Chi practitioners demonstrating a whole set of 42-form Tai Chi movements were recorded with two cameras. The APAS motion analysis system was used to identify the foot supporting and stepping characteristics during the practice. Seven foot support patterns and six step directions were identified. The results revealed that compared with normal walking, Tai Chi movement had more double support and less single support total duration. The duration of each support pattern was longer and movement from one pattern to the next was slow. The duration of each step direction was short, and changes of direction were frequent. It was expected that support patterns changed slowly, and combined with various step directions, they were found to be better than those of walking in simulating the gait challenges that may be encountered in daily activities. / Part 2: The plantar pressure distribution during Tai Chi exercise. The purpose of this study is to describe and quantify the plantar pressure distribution characteristics during Tai Chi exercise and to explain the beneficial effects of Tai Chi on balance control and muscle strength as compared with normal walking. Sixteen experienced Tai Chi practitioners participated in this study. Five typical Tai Chi movements represented by stepping forward, backward, sideways, up-down, and fixing could be isolated from the whole set of 42-form Tai Chi. The pressure-time integral, ground reaction force, displacement of center of pressure during the performance of the five typical movements were recorded and analyzed by the Pedar-X insole system (Germany). Results showed that during Tai Chi movements, the loading of the first metatarsal head and the great toe were significantly greater than in other regions (p&lt;0.05). The ground reaction forces varied between the Tai Chi movements and normal walking. Compared with normal walking, the locations of the center of pressure in the Tai Chi movements were significantly more medial and posterior at initial contact (p&lt;0.05), and were significantly more medial and anterior at the end of contact with the ground (p&lt;0.05). The displacements of the center of pressure were significantly wider (p&lt;0.05) in the mediolateral direction in the forward, backward and sideways Tai Chi movements. The displacement was significantly larger (p&lt;0.05) in the anterposterior direction in the forward movement. The plantar pressure characteristics of Tai Chi movements found in this study may be one of the important factors for Tai Chi's improvement of balance control and muscle strength. / Part 3. The duration and plantar pressure distribution during one-leg stance in Tai Chi exercise. The aim of this study is to quantify the one-leg stance duration and plantar pressure distribution during the one-leg stance in Tai Chi and to try to elaborate on its probable effects on the ability to balance on one leg. Sixteen experienced Tai Chi practitioners participated in this study. The Novel Pedar-X insole system (Germany) was used to record the plantar forces during the execution of a set of 42-form Tai Chi movements and during normal walking. The one-leg stance duration and plantar pressure distribution during the one-leg stance were analyzed. Results showed that in Tai Chi, the total duration spent in the one-leg stance was less (p&lt;0.05), the duration of each one-leg stance was longer (p&lt;0.01) and the medial-lateral displacement of the center of pressure was greater (p&lt;0.05) than during normal walking. The peak pressure and pressure-time integral of the second and third metatarsal heads and the fourth and fifth metatarsal heads were significantly greater (p&lt;0.05) than those of other plantar regions during the one-leg stance in normal walking; whereas the peak pressure and pressure-time integral of the first metatarsal head and the great toe were significantly greater (p&lt;0.05) than those of other plantar regions during the one-leg stance in Tai Chi. The longer duration of each one-leg stance and the plantar pressure distribution characteristics during the one-leg stance in Tai Chi may be associated with an improved ability to balance on one leg. / Part 4. The muscle contraction characteristics of the lower extremities during Tai Chi exercise. The objective of this study is to examine the muscle contraction characteristics of the lower extremities during Tai Chi exercise and to explain the beneficial effect of Tai Chi on the improvement of muscle strength. Sixteen experienced Tai Chi practitioners participated in this study. Five typical Tai Chi movements, represented by stepping in forward, backward, sideways, up-down and fixing were selected. The electromyographic activity of the rectus femoris, semitendinosus, gastrocnemius, and anterior tibialis muscles were recorded by Delsys electromyography measurement system (USA) during the performance of five typical Tai Chi movements. (Abstract shortened by UMI.) / Mao Dewei. / "August 2006." / Adviser: Youlian Hong. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1598. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 102-112). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-18T17:04:16Z No. of bitstreams: 1 CarlosAlbertoMartinsCarvalho_dissert.pdf: 239221 bytes, checksum: cfe9babd8785d6d5c559e8d50c570025 (MD5) / Made available in DSpace on 2018-10-18T17:04:16Z (GMT). No. of bitstreams: 1 CarlosAlbertoMartinsCarvalho_dissert.pdf: 239221 bytes, checksum: cfe9babd8785d6d5c559e8d50c570025 (MD5) Previous issue date: 2018-05-13 / Chronic venous disease, with symptoms that lead to disability to work and loss of quality of life, affects millions of people worldwide. Objective: To evaluate the reduction of edema and pain in the lower limbs by walking while wearing elastic compression stockings. Patients and Methods: Twenty-one female patients with edema and pain of the lower limbs and with ages ranging between 32 and 72 years (mean = 49.5 years) were prospectively studied. Patients with signs and symptoms of chronic venous disease classified as C3 of the Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification were included. All patients were evaluated by volumetry using the water displacement technique before and after each treatment session. Pain was analyzed using an analog pain scale that ranged from 0 to 10; where 0 indicated no pain and 10 the maximum bearable pain. Patients were randomized to use a stocking during the day; no stocking or walking on a treadmill for 50 minutes at 3 km/h in the evening. A 20/30 mmHg, knee-length elastic compression stocking was worn. The paired t-test and Wilcoxon test were used for data analysis. Results: The mean leg volume increased from 3041.42 mL in the morning to 3084.35 mL in the evening when no stocking was used during the day (p-value <0.0001). After walking on the treadmill, the volume dropped from 3099.17 mL to 3070.92 mL (p-value <0.001). On using compression stockings during the day, the initial mean volume of 3042.23 mL reduced to 3021.28 mL by the evening (p-value <0.0001). With regard to pain, there was a significant reduction after walking on a treadmill with elastic stockings (p-value <0.003). Stockings significantly reduced the pain during the course of the day (p-value <0.01). Elastic stockings donned in the evening were well tolerated, as they did not cause discomfort or allergic processes. Conclusions: Reductions in swelling and pain of the legs that develops over the course of the day can be reduced by using elastic stockings while walking on a treadmill in the evening. / Doença venosa crônica afeta milhões de pessoas em todo mundo, causando sinais e sintomas que levam a desabilidade para o trabalho e perda da qualidade de vida. Objetivo: Avaliar redução do edema e da dor nos membros inferiores com caminhada e meia elástica. Casuística e Método: Foram estudados prospectivamente 21 pacientes do sexo feminino com edema e dor nos membros inferiores, cuja idade variou entre 32 e 72 anos (média = 49,5 anos). Foram inclusos pacientes com sinais e sintomas da doença venosa crônica, classificação C3 do CEAP. Todas pacientes foram avaliadas pela volumetria por técnica de deslocamento de água antes e após cada tratamento. Para análise da dor foi utilizada escala analógica de dor que variava de 0 a 10, sendo 0 sem dor e 10 na sua avaliação máxima. Após sorteio, foram inseridas nas referidas avaliações com meia, sem meia durante o dia, e após atividade em esteira por 50 minutos com velocidade de 3 km/h no período vespertino com meia elástica compressão 20/30 e tamanho ¾. A análise de dados foi efetuada por meio dos testes t pareado e de Wilcoxon. Resultados: O volume médio dos membros inferiores no período matutino foi 3041,42 mL aumentando sem uso da meia no período vespertino para 3084,35 mL (p<0,0001). Após atividade em esteira, houve redução de 3099,17 mL para 3070,92 mL (p<0,001). Com uso de meia elástica durante o dia, o volume médio inicial de 3042,23 mL reduziu para 3021,28 mL (p<0,0001). Com relação à dor, houve redução significativa após caminhada em esteira com meia elástica (p<0,003). O uso de meia proporcionou redução significativa da dor no transcorrer do dia (p<0,01). Em relação à tolerância da meia elástica colocada no período vespertino, a resposta foi positiva e não desconforto ou processos alérgicos. Conclusões: A redução do edema e da dor nos membros inferiores no transcorrer do dia pode ocorrer com uso de meia elástica efetuando caminhada em esteira no período vespertino.