Ankylosing Spondylitis (AS) and Chronic Pain Syndrome (CPS) can be treated in many different ways. I found a problem in the balance of healing modalities surrounding diagnosis and care of illness and disease. This struggle is not singular to AS and CPS, but universal to physical and mental concerns. Some effective treatments and therapies are not recognized as such or are just beginning to become so. The scope of my work reflects on the course of my life. It was heavily influenced by the way my medical care was managed from an early age and how it evolved over the years. Through my educational program, I examined the necessity to bridge the gap between treatment paradigms and to expand on a broader, more inclusive, healing rubric. This rubric includes a broader emphasis on skill-based and complementary and alternative medicines. The viability to incorporate holistic health therapies earlier in life is explored through my use of the Scholarly Personal Narrative (SPN) qualitative research method. I chose this methodology because scientific fact could be argued either way for one therapeutic approach over another. By incorporating lived experience through SPN the union and cohesion necessary in all healing modalities, and their positive aspects, can be seen. The truth becomes self-evident. The results of this examination showed awareness earlier in life toward alternative and holistic treatments being paramount. Parents and educators lack information concerning modern therapeutic approaches. It also showed each situation will vary, but choice in treatment for ailments and illness of all kinds is not only viable, but highly recommended and researched. Access issues such as health insurance remain obstacles with some treatments and therapies, while others are a matter of cost prohibition, such as nutrition therapies. The implications of my work indicate a need for earlier incorporation of holistic healing programs and skill based therapies alongside perpetuated medical models in early childhood development and education. In conclusion, awareness towards medical concerns and how we as a society treat them can be improved upon by systemically incorporating less harmful therapies earlier in life. Fostering relations between medical providers, care providers and educators for students' wellbeing should be the foreground of any educational policy. Educators and parents alike should be made aware of and take advantage of effective skill-based treatments before a physical or mental condition surfaces or medication only approaches are authoritatively recommended. Integrating programs that build strong mental resilience and focus on youth development and education can reduce the necessity for more invasive treatments or medications should an ailment or illness develop.

De etiologia multifatorial, a síndrome dolorosa fêmoro-patelar (SDPF) acomete de 7 a 15% da população, em sua maioria jovens, adultos e ativos. Causa dor difusa anterior ou retropatelar e é exacerbada durante atividades funcionais, como subir e descer degraus, permanecer por um período prolongado sentado, agachado ou ajoelhado (COWAN, BENNELL e HODGES, 2002). Tanto o processo de avaliação quanto a evolução do tratamento baseiam-se, fundamentalmente, no relato de dor feito pelo paciente e na incapacidade funcional. Diagnosticar corretamente o distúrbio possibilitaria um tratamento mais adequado e permitiria o acompanhamento do quadro evolutivo do paciente ao longo do tratamento proposto. Desta maneira, propôs-se a análise de alguns parâmetros biomecânicos para melhor caracterização destes indivíduos. 33 voluntárias - 11 com diagnóstico médico de dor fêmoro-patelar e 22 clinicamente normais - foram submetidas à avaliação por meio de eletromiografia de superfície das porções medial e lateral do quadríceps; análise tridimensional de movimento; e plataforma de força durante a subida de degraus. As voluntárias do grupo SDFP foram caracterizadas por um atraso no tempo de atividade máxima do músculo vasto medial em relação ao vasto lateral (4 ms), aumento da rotação externa do fêmur (3,14 graus) e menor variação global do torque (1,14 Nm), quando comparadas aos indivíduos do grupo controle. Os resultados obtidos complementam-se e ajudam a entender características de comportamento neuromotor em indivíduos com dor fêmoro-patelar. Conjuntamente, esses instrumentos apresentam grande potencial para a avaliação e classificação dos indivíduos com relação à síndrome. / From multifactorial etiology, patellofemoral pain syndrome (PFPS) affects 7 to 15% of the population, mostly young, adults and active people. It causes anterior or behind patella diffuse pain and is exacerbated during functional activities such as climbing and descending stairs or stay for a long time sitting, kneeling or crouching down (COWAN, BENNELL e HODGES, 2002). The evaluation process as much as the evolution of treatment is fundamentally based in the reporting of pain by the patient and the functional disability. Correct diagnostic of the disorder would allow a more appropriate treatment as well as to keep up with the patient evolution during the proposed treatment. Thus, it was proposed the biomechanical analysis of some parameters to better characterize these individuals. 33 female volunteers - 11 with medical diagnosis of patellofemoral pain and 22 clinically normal - were submitted to evaluation of surface electromyography of the medial and lateral portions of the quadriceps, three-dimensional motion analysis and force plate during the ascent of steps. The volunteers of the PFPS group were characterized by a delay in time of maximum activity of the vastus medialis muscle related to the vastus lateralis (4 ms), increased femoral external rotation (3.14 degrees) and less overall variation in the torque (1.14 Nm) when compared to individuals in the control group. The results complement each other and help to understand features of neuromotor behavior in individuals with patellofemoral pain. Together, these tools have great potential for assessment and classification of these individuals related to the syndrome.

A síndrome da dor patelofemural é uma das disfunções mais comuns que acometem o joelho, principalmente mulheres jovens fisicamente ativas. No entanto, o tratamento permanece desafiador por carecer de bases científicas que direcionem sua reabilitação. Distúrbios no alinhamento estático e dinâmico dos membros inferiores, como a pronação excessiva do retropé, têm sido associados na clínica e embasados teoricamente como fatores de risco para a disfunção. No entanto, estudos experimentais que embasem esta relação ainda são controversos. O objetivo geral deste estudo foi verificar a influência da síndrome da dor patelofemural no alinhamento postural do retropé e joelho, assim como na distribuição da pressão plantar durante a fase apoio do descer escadas e em três subfases do apoio da marcha. Foram estudados 77 adultos jovens de ambos os sexos, divididos em grupo controle (GC=47) e grupo síndrome da dor patelofemural (GSPF=30). Para responder a questões científicas específicas, foram realizados três experimentos. O experimento 1 teve o objetivo específico de verificar a associação entre a síndrome da dor patelofemural e o alinhamento postural dos membros inferiores (n=77; GC=47,GSPF=30). Para tanto, foram avaliadas três medidas clínicas: o ângulo do retropé, o ângulo Q (fotogrametria digital) e a orientação médiolateral da patela (método adaptado de Mc Connell). O experimento 2 teve como objetivo específico investigar a distribuição da pressão plantar de indivíduos com e sem diagnóstico de síndrome da dor patelofemural durante o descer escadas, e avaliar a dor dos sujeitos com essa disfunção antes e após a tarefa proposta (n=74; GC=44,GSPF=30). Para tanto, avaliouse a distribuição da pressão plantar por meio de palmilhas capacitivas (Pedar X System) na fase de apoio do descer escadas e a dor referida pelos sujeitos pela escala analógica visual de dor antes e depois da tarefa motora. O experimento 3 (n=57; GC=35,GSPF=22) buscou especificamente avaliar a influência da síndrome da dor patelofemural na distribuição da pressão plantar durante o contato inicial, médio-apoio e propulsão da fase de apoio da marcha. Os principais resultados demonstraram que não houve influência da disfunção no alinhamento postural do retropé e joelho. No entanto, durante o descer escadas, a síndrome da dor patelofemural esteve associada à um contato medialmente direcionado no retropé e médio-pé, assim como menores sobrecargas plantares, provavelmente associadas ao aumento significativo da dor relatada pelos sujeitos após a tarefa. Na marcha, os sujeitos com a disfunção realizaram novamente um contato inicial medialmente direcionado no retropé e uma propulsão mais lateralizada no antepé. Os resultados deste estudo mostram que a síndrome da dor patelofemural não esteve relacionada ao alinhamento postural do retropé e joelho, mas influenciou o padrão dinâmico da distribuição da pressão plantar tanto na marcha como no descer escadas. Estes achados confirmam a importância da avaliação dinâmica durante a reabilitação dos indivíduos com esta disfunção. / Patellofemoral pain syndrome is one of the most common dysfunctions of the knee, particularly among young physically active females. Its treatment remains challenger due to the lack of scientific rationales bases to guide its rehabilitation. Static and dynamic misalignment of the lower extremity, like excessive rearfoot pronation has been clinically and theoretically associated as risk factors for this dysfunction. However, scientific studies to confirm this association are still controversial. The general purpose of this study was to verify the influence of patellofemoral pain syndrome on rearfoot and knee postural alignment as well as on plantar pressure distribution during the stance phase of stair descent and three sub phases of stance gait. 77 young adults of both sexes divided in to control group (GC=47) and patellofemoral pain goup(PFPG=30) were studied. Three experiments were realized in order to respond the specific scientific questions. The experiment 1 had the specific purpose of verify the association between patellofemoral pain syndrome and postural alignment of rearfoot and knee (n=77; CG=47, PFPG=30). Therefore, three clinical measurements were evaluated: rearfoot angle, Q angle (digital photogrammetry) and the medio-lateral orientation of the patella (adapted from McConnell). The experiment 2 aimed specifically to investigate plantar pressure distribution in subjects with and without patellofemoral pain syndrome, during the stair descent, and evaluate the pain referred by the subjects before and after the motor task (n=74;CG=44,PFPG=30), plantar pressure distribution was evaluated with capacitive insoles(Pedar X System) during the stance phase of stair descent as well as the pain referred by the subjects by Visual Analogue Scale before and after the task. The experiment 3 intended specifically to verify the influence of patellofemoral pain syndrome on plantar pressure distribution during initial contact, midstance and propulsion of the gait stance (n=57; GC=35, GSPF=22). The principal results of this study showed that there was no influence of the dysfunction on postural alignment of rearfoot and knee. However, patellofemoral pain syndrome during the stair descent was related to a medially directed contact at the rearfoot and midfoot and lower plantar loads probably due to the increase in pain observed after the task. During gait, the subjects with the dysfunction showed again an initial contact medially directed at the rearfoot and laterally directed propulsion on forefoot. The results of this study show that patellofemoral pain syndrome was not associated to postural alignment but influenced the plantar pressure distribution during gait as well as stair descending task. These findings confirm the importance of the dynamic evaluation of subjects with this dysfunction during their rehabilitation.

A síndrome da dor patelofemural é uma das disfunções mais comuns que acometem o joelho, principalmente mulheres jovens fisicamente ativas. No entanto, o tratamento permanece desafiador por carecer de bases científicas que direcionem sua reabilitação. Distúrbios no alinhamento estático e dinâmico dos membros inferiores, como a pronação excessiva do retropé, têm sido associados na clínica e embasados teoricamente como fatores de risco para a disfunção. No entanto, estudos experimentais que embasem esta relação ainda são controversos. O objetivo geral deste estudo foi verificar a influência da síndrome da dor patelofemural no alinhamento postural do retropé e joelho, assim como na distribuição da pressão plantar durante a fase apoio do descer escadas e em três subfases do apoio da marcha. Foram estudados 77 adultos jovens de ambos os sexos, divididos em grupo controle (GC=47) e grupo síndrome da dor patelofemural (GSPF=30). Para responder a questões científicas específicas, foram realizados três experimentos. O experimento 1 teve o objetivo específico de verificar a associação entre a síndrome da dor patelofemural e o alinhamento postural dos membros inferiores (n=77; GC=47,GSPF=30). Para tanto, foram avaliadas três medidas clínicas: o ângulo do retropé, o ângulo Q (fotogrametria digital) e a orientação médiolateral da patela (método adaptado de Mc Connell). O experimento 2 teve como objetivo específico investigar a distribuição da pressão plantar de indivíduos com e sem diagnóstico de síndrome da dor patelofemural durante o descer escadas, e avaliar a dor dos sujeitos com essa disfunção antes e após a tarefa proposta (n=74; GC=44,GSPF=30). Para tanto, avaliouse a distribuição da pressão plantar por meio de palmilhas capacitivas (Pedar X System) na fase de apoio do descer escadas e a dor referida pelos sujeitos pela escala analógica visual de dor antes e depois da tarefa motora. O experimento 3 (n=57; GC=35,GSPF=22) buscou especificamente avaliar a influência da síndrome da dor patelofemural na distribuição da pressão plantar durante o contato inicial, médio-apoio e propulsão da fase de apoio da marcha. Os principais resultados demonstraram que não houve influência da disfunção no alinhamento postural do retropé e joelho. No entanto, durante o descer escadas, a síndrome da dor patelofemural esteve associada à um contato medialmente direcionado no retropé e médio-pé, assim como menores sobrecargas plantares, provavelmente associadas ao aumento significativo da dor relatada pelos sujeitos após a tarefa. Na marcha, os sujeitos com a disfunção realizaram novamente um contato inicial medialmente direcionado no retropé e uma propulsão mais lateralizada no antepé. Os resultados deste estudo mostram que a síndrome da dor patelofemural não esteve relacionada ao alinhamento postural do retropé e joelho, mas influenciou o padrão dinâmico da distribuição da pressão plantar tanto na marcha como no descer escadas. Estes achados confirmam a importância da avaliação dinâmica durante a reabilitação dos indivíduos com esta disfunção. / Patellofemoral pain syndrome is one of the most common dysfunctions of the knee, particularly among young physically active females. Its treatment remains challenger due to the lack of scientific rationales bases to guide its rehabilitation. Static and dynamic misalignment of the lower extremity, like excessive rearfoot pronation has been clinically and theoretically associated as risk factors for this dysfunction. However, scientific studies to confirm this association are still controversial. The general purpose of this study was to verify the influence of patellofemoral pain syndrome on rearfoot and knee postural alignment as well as on plantar pressure distribution during the stance phase of stair descent and three sub phases of stance gait. 77 young adults of both sexes divided in to control group (GC=47) and patellofemoral pain goup(PFPG=30) were studied. Three experiments were realized in order to respond the specific scientific questions. The experiment 1 had the specific purpose of verify the association between patellofemoral pain syndrome and postural alignment of rearfoot and knee (n=77; CG=47, PFPG=30). Therefore, three clinical measurements were evaluated: rearfoot angle, Q angle (digital photogrammetry) and the medio-lateral orientation of the patella (adapted from McConnell). The experiment 2 aimed specifically to investigate plantar pressure distribution in subjects with and without patellofemoral pain syndrome, during the stair descent, and evaluate the pain referred by the subjects before and after the motor task (n=74;CG=44,PFPG=30), plantar pressure distribution was evaluated with capacitive insoles(Pedar X System) during the stance phase of stair descent as well as the pain referred by the subjects by Visual Analogue Scale before and after the task. The experiment 3 intended specifically to verify the influence of patellofemoral pain syndrome on plantar pressure distribution during initial contact, midstance and propulsion of the gait stance (n=57; GC=35, GSPF=22). The principal results of this study showed that there was no influence of the dysfunction on postural alignment of rearfoot and knee. However, patellofemoral pain syndrome during the stair descent was related to a medially directed contact at the rearfoot and midfoot and lower plantar loads probably due to the increase in pain observed after the task. During gait, the subjects with the dysfunction showed again an initial contact medially directed at the rearfoot and laterally directed propulsion on forefoot. The results of this study show that patellofemoral pain syndrome was not associated to postural alignment but influenced the plantar pressure distribution during gait as well as stair descending task. These findings confirm the importance of the dynamic evaluation of subjects with this dysfunction during their rehabilitation.

Anterior knee pain (AKP) is a common, chronic lower limb musculoskeletal overuse condition that represents substantial morbidity to those affected, and has a significant impact on the health care industry. Health practitioners frequently prescribe foot orthoses in the management of AKP as an alternative or adjunct to multimodal physiotherapy. The primary aim of this thesis was to investigate the clinical efficacy of foot orthoses in AKP, utilising high-quality research methodologies. The two systematic reviews conducted have identified a significant gap in the literature regarding evidence from randomised clinical trials (RCTs) for foot orthoses in AKP and other lower limb overuse conditions. While the best evidence for AKP management was for multimodal physiotherapy, there was insufficient evidence to support or refute the use of foot orthoses in the treatment of lower limb overuse conditions, including AKP. Meta-analysis provided evidence to support the use of foot orthoses in the prevention of the first incidence of lower limb overuse conditions. An interesting finding was evidence from pooled and individual study data of no difference between custom and prefabricated foot orthoses in both treatment and prevention of lower limb overuse conditions, inferring that either type of orthosis may be utilised. Both systematic reviews highlighted substantial methodological flaws of the included studies, and recommended that future studies include larger participant numbers, longer participant follow-up, more consistent use of reliable and valid outcome measures and reporting of outcome data, and utilisation of the CONSORT guidelines in the design and reporting of RCTs. A 12-month prospective RCT investigated the short- and long-term clinical efficacy of prefabricated foot orthoses in the treatment of 179 participants with AKP. Foot orthoses were more effective than flat shoe inserts in the short term, implying that their contoured form has some therapeutic effect. Foot orthoses were not significantly different to multimodal physiotherapy over 12 months, nor was there any benefit in adding foot orthoses to physiotherapy. Considering that all groups experienced clinically meaningful long-term improvements in pain and function, clinicians may prescribe foot orthoses for AKP to hasten recovery. Findings of post-hoc analyses to develop a clinical prediction rule indicate that those of older age and shorter height, who have a lower severity of AKP and a more mobile midfoot, are more than twice as likely to experience a successful outcome with foot orthoses. As a secondary aim, this thesis has provided a more comprehensive profile of AKP as a condition. Baseline data from the RCT participants confirms previous reports of higher rates of AKP in females, and a tendency towards bilaterality and chronicity. This AKP sample did not differ from asymptomatic individuals in terms of body mass index, physical activity level, general and mental health, and foot posture, although they tended to have a more mobile foot under load. These characteristics tend to be homogenous across a number of published RCTs, indicating that the findings of the RCT described above are likely to be generalisable to the broader population with AKP. An additional finding in this group was that those with AKP of long duration, higher pain levels, lower functional levels, and an overall lower score on a specific measure of AKP have a poorer prognosis over 12 months, irrespective of their age, gender or morphometry. These findings suggest that, in order to improve prognosis and the chance of a successful outcome, the primary goals of intervention should be to reduce the severity and duration of AKP, through the use of early intervention with foot orthoses, multimodal physiotherapy, or a combination of the two.

Chronic pelvic pain is a condition which receives less attention in men than in women. It is often difficult to diagnose and more difficult to treat. The new classification of prostatitis and its variants has introduced the term ‘chronic pelvic pain syndrome’ which underlines the difficulties in dealing with this disorder which may represent a variety of chronically painful conditions with a large functional component. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Made available in DSpace on 2016-06-02T20:18:18Z (GMT). No. of bitstreams: 1 4640.pdf: 11819710 bytes, checksum: 10075c7c13e1fbef1d818aeef1a9a5ee (MD5) Previous issue date: 2012-10-22 / Financiadora de Estudos e Projetos / Although the incidence of patellofemoral pain (PFP) is higher in females, it also occurs quite commonly in males. Previous studies have demonstrated differences in lower limb kinematics, strength and muscular activation between males and females. Moreover, it has been hypothesized that the trunk movement in the frontal plane might influence the knee joint. However, information about trunk and lower limbs biomechanics between males and females with PFP is sparse. Therefore, the objective of this thesis was to evaluate trunk, pelvis, hip and knee kinematics, hip eccentric torque and muscular activation in males and females with and without PFP during functional activities. Eighty volunteers were evaluated and equally divided into four groups: Females PFP, Female Controls, Males PFP and Male Controls. The 3D kinematics was evaluated using an electromagnetic tracking system (Ascension Technology Corporation, Burlington, VT), the electromyographic signals were collected with a Bagnoli eightchannel system (Delsys Inc., Boston, MA) and the hip eccentric torque was evaluated using an isokinetic dynamometer (Biodex Multi-Joint System 2; Shirley, NY). Males and females with PFP demonstrated higher ipsilateral trunk lean, contralateral pelvic drop, hip adduction and knee abduction during single leg squat and step-down task, when compared to the controls. These kinematic alterations were accompanied by reduced hip abduction and external rotation eccentric torque. As opposed to the males, females with PFP also showed greater hip internal rotation and reduced gluteus medius activation during single leg squat. In addition, greater hip adduction, hip internal rotation and knee abduction were associated with greater pain level and reduced function in individuals with PFP. Despite many similarities in findings for males and females with PFP, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFP. / Apesar da incidencia da dor patelofemoral (DPF) ser maior nas mulheres, esta tambem e comum nos homens. Estudos tem demonstrado diferencas na cinematica, forca e ativacao muscular dos membros inferiores entre homens e mulheres. Alem disso, tem sido hipotetizado que os movimentos do tronco no plano frontal podem influenciar a articulacao do joelho. Porem, ha escassez de informacao a respeito da biomecanica do tronco e membros inferiores entre homens e mulheres com DPF. Assim, o objetivo desta tese foi avaliar a cinematica do tronco, pelve, quadril e joelho, torque excentrico e ativacao muscular do quadril em homens e mulheres com e sem a DPF durante atividades funcionais. Foram avaliados 80 voluntarios igualmente divididos em quatro grupos: Mulheres DPF, Mulheres Controles, Homens DPF e Homens Controles. A cinematica articular 3D foi avaliada utilizando um sistema de rastreamento eletromagnetico (Ascension Technology Corporation, Burlington, VT), os sinais eletromiograficos foram coletados por um sistema de 8 canais Bagnoli (Delsys Inc., Boston, MA) e o torque excentrico do quadril foi mensurado com o dinamometro isocinetico (Biodex Multi-Joint System 2; Shirley, NY). Homens e mulheres com a DPF demonstraram aumento da inclinacao ipsilateral do tronco, queda pelvica contralateral, aducao do quadril e abducao do joelho durante o agachamento unipodal e a descida de degrau, quando comparados aos controles. Essas alteracoes cinematicas foram acompanhadas da diminuicao do torque excentrico dos abdutores e rotadores laterais do quadril. Ao contrario dos homens, as mulheres com a DPF tambem apresentaram aumento da rotacao medial do quadril e diminuicao da ativacao do gluteo medio durante o agachamento unipodal. Alem disso, a maior aducao e rotacao medial do quadril e abducao do joelho foram associadas a maior dor e a funcao reduzida nos individuos com a DPF. Assim, apesar das similaridades dos achados entre homens e mulheres com a DPF, existem algumas diferencas sexo-especificas que merecem consideracao em estudos futuros e durante a avaliacao e o tratamento das mulheres com a DPF.

Made available in DSpace on 2016-12-06T17:06:48Z (GMT). No. of bitstreams: 1 Lisiane Piazza.pdf: 1405416 bytes, checksum: 55ba3d2e707b8e4658ae86707f239905 (MD5) Previous issue date: 2012-02-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The purpose of this study was to understand the biomechanical patterns adopted by subjects with and without PFPS during perform five daily living activities (walking on a flat surface, up and down stairs and ramp). Participated of this study 65 individuals, females, of which 57 were selected: 26 with PFPS (PFPSG) and 31 clinically healthy (CG), matched by age, height and body mass. The data were collected in the Biomechanics Lab at the University of Passo Fundo RS. Initially, was applied an evaluation form to characterize the subjects and the Kujala Questionnaire to assess the symptoms and functional limitations related to the patellofemoral joint. Was evaluated plantar pressure distribution (peak pressure, contact area and contact time) in six regions (medial forefoot, lateral forefoot, midfoot, medial rearfoot, central rearfoot and lateral rearfoot) through the Pedar-X during perform five daily living activities. Kinematic analysis was also carried out (maximum angle of rearfoot eversion and % of support phase in which this angle has been reached) using the APAS (Ariel Performance Analysis System) as well as isokinetic evaluation (peak torque and work concentric/concentric) of the knee flexors and extensors in two speeds (180°/s and 60°/s) using the Biodex Multi Joint System 3. The order of the assessments was randomized. Pain intensity before and after perform the activities was assessed by Visual Numeric Scale (VNS). Data were analyzed using descriptive and inferential statistics (U- Mann Whitney test, independent T-test, Wilcoxon and ANOVA 2x6), with a significance level of p ≤ 0.05.The PFPSG had a lower score on the Kujala Questionnaire in relation to CG (p=0,01). There were no differences between groups in peak pressures, contact area and contact time in six plantar regions analyzed during the five daily living activities. Additionally, there were no differences between groups regarding the magnitude of the maximum angle of rearfoot eversion. There was also increased pain after perform the five daily living activities (p = 0.01) and isokinetic evaluation at 180 ° / s (p = 0.007) and 60 ° / s (p = 0.01). The results of this study, in the experimental conditions used, suggested that there isn t a behavior pattern in the plantar pressure distribution that differentiate subjects with and without PFPS during perform five daily living activities proposed in this study. However, subjects with PFPS reach maximum rearfoot eversion in early stance phase of walking on a flat surface, suggesting a strategy to avoid a possible appearance or worsening of their symptoms and have low knee flexors and extensors peak torque and knee extensors work compared to asymptomatic subjects. / Este estudo teve como objetivo compreender os padrões biomecânicos adotados por sujeitos com e sem SDPF na realização de cinco atividades funcionais (marcha em superfície plana, subir e descer escadas e rampa). Participaram 65 indivíduos do gênero feminino, dos quais foram selecionados 57: 26 com SDPF (GSDPF) e 31 clinicamente saudáveis (GC), pareados em idade, estatura e massa corporal. Os dados foram coletados no Laboratório de Biomecânica da Universidade de Passo Fundo-RS. Inicialmente foi aplicada uma ficha de avaliação para caracterização dos sujeitos e o Questionário de Kujala para avaliação dos sintomas e limitações funcionais relativos à articulação patelofemoral. Foi avaliada a distribuição da pressão plantar (pico de pressão, área de contato e tempo de contato) em seis regiões plantares (antepé medial, antepé lateral, médio pé, retropé medial, retropé central e retropé lateral) por meio do Pedar-X durante a realização das cinco atividades funcionais. Foram realizadas também a análise cinemática (ângulo máximo de eversão do retropé e % da fase de apoio em que este ângulo foi atingido) através do APAS (Ariel Performance Analysis System) e avaliação isocinética (pico de torque e trabalho concêntrico/concêntrico) dos flexores e extensores do joelho nas velocidades de 180°/s e 60°/s através do dinamômetro isocinético Biodex Multi Joint System 3. A ordem de realização das avaliações foi randomizada. A intensidade da dor dos sujeitos antes e após as atividades foi avaliada pela Escala Visual Numérica (EVN). Os dados foram analisados por meio da estatística descritiva e inferencial (Testes U de Mann Whitney, T-independente, Wilcoxon e Anova 2x6), com nível de significância de p≤0,05. O GSDPF apresentou menor pontuação no Questionário de Kujala em relação ao GC (p=0,01). Não foram observadas diferenças entre os grupos no pico de pressão, área de contato e tempo de contato nas seis regiões plantares analisadas durante as cinco atividades funcionais. Adicionalmente, não foram constatadas diferenças entre os grupos em relação à magnitude do ângulo máximo de eversão do retropé. No entanto, o GSDPF atingiu este ângulo mais cedo na fase de apoio da marcha que o GC (p=0,01). A avaliação isocinética evidenciou menor pico de torque dos flexores (p=0,005 e p=0,03) e extensores (p=0,006 e p=0,004) do joelho nas velocidades de 180°/s e 60°/s e menor trabalho da musculatura extensora do joelho (p=0,05 e p=0,01) em ambas velocidades do teste isocinético no GSDPF. Houve também exacerbação da dor dos sujeitos após a realização das cinco atividades funcionais (p=0,01) e avaliação isocinética a 180°/s (p=0,007) e 60°/s (p=0,01). Sendo assim, os resultados do presente estudo, nas condições experimentais utilizadas, sugerem que não existe um padrão de comportamento da distribuição da pressão plantar que diferencie sujeitos com e sem SDPF durante a realização das cinco atividades funcionais propostas no estudo. No entanto, sujeitos com SDPF alcançam a eversão máxima do retropé mais cedo na fase de apoio da marcha em superfície plana, sugerindo uma estratégia para evitar um possível surgimento ou agravo dos seus sintomas, além de apresentar menor torque dos flexores e extensores do joelho e trabalho dos extensores do joelho em relação a sujeitos assintomáticos.

Orientador: Evanisi Teresa Palomari / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-11T13:22:09Z (GMT). No. of bitstreams: 1 Oliveira_CamilaAdalgisa_M.pdf: 2490137 bytes, checksum: 726910ed57d76e40a7eb842f6dfc5cfa (MD5) Previous issue date: 2008 / Resumo: A disfunção femoropatelar é causada por um desequilíbrio muscular entre as porções medial e lateral do músculo quadríceps. Dessa forma, o tratamento enfatiza o fortalecimento seletivo do músculo vasto medial oblíquo, promovendo assim um realinhamento do aparelho extensor. O objetivo deste estudo foi avaliar o efeito da estimulação elétrica neuromuscular por meio do torque isométrico e área de secção transversa do músculo quadríceps e atividade eletromiográfica da porção oblíqua dos músculos vasto medial e vasto lateral, em indivíduos normais e portadores de disfunção femoropatelar. Participaram do estudo 28 voluntárias sedentárias (14 saudáveis e 14 portadoras da disfunção). Foram realizados dois treinos: a eletroestimulação isoladamente e a associação com a contração isométrica voluntária. Para o fortalecimento seletivo do músculo vasto medial oblíquo e adutor magno foi utilizada uma corrente de média freqüência por um período de 24 dias. A análise eletromiográfica por meio do protocolo isométrico foi realizada por um Myosystem-Br1 da marca DataHominis Tecnologia®. A célula de carga de 100 Kgf acoplada ao módulo permitiu a análise da força muscular do quadríceps. O exame de ressonância magnética possibilitou o cálculo da área de secção transversa do músculo quadríceps. Todas as avaliações foram realizadas pré e pós-treino. O teste de Wilcoxon foi aplicado para verificar o resultado após o treino e o teste de Mann-Whitney para a análise intergrupos pré e pós-treino, ambos com um nível de significância de p = 0,05. Os resultados apontaram aumento significativo na força muscular do quadríceps pós-treinamento em todos os grupos treinados, na área de secção transversa do músculo quadríceps para os grupos GC II e GD I, do músculo vasto medial para os grupos GC I, GC II e GD I, e do grupo adutor em todos os grupos avaliados, exceto o grupo GC I. A amplitude do sinal mioelétrico não sofreu alterações após o treino, as freqüências média e mediana diminuíram nos grupos GD I a 45° e 90° de flexão da articulação do joelho, e no grupo GC II a 60° de flexão da articulação do joelho, respectivamente. Contudo, podemos concluir que a estimulação elétrica neuromuscular mostrou-se efetiva no tratamento de portadores da disfunção femoropatelar / Abstract: The patellofemoral syndrome is caused by a muscular disequilibrium between the portions medial and lateral of the muscle quadriceps. This way, the treatment emphasizes the selective strenght of the vastus medialis oblique muscle, thus promoting a realignment of the extensor device. The objective of this study was to evaluate the effect of the electric stimulation by means of the isometric torque and area of transverse section of the muscle quadriceps and electromyography activity of the oblique portion of the muscles vastus medialis and vastus lateralis, in normal and with patellofemoral syndrome individuals. In this study had participated 28 sedentary volunteers (14 healthful and 14 carriers of the syndrome). Two sections were made carried through: the electric stimulation separately and the association with the voluntary isometric contraction. For the selective strenght of the vastus medialis oblique muscle and great expository were used a chain of average frequency for a period of 24 days. The electromyography analysis by means of the isometric protocol was carried through by a Myosystem-Br1 of the mark DataHominis Tecnologia®. The load cell of 100 Kgf connected to the module allowed the analysis of the muscular force of quadríceps. The examination of magnetic resonance made possible the calculation of the transverse section area of the muscle quadriceps. All the evaluations were carried through daily pay and after-trainings. The test of Wilcoxon was applied to verify the result after the trainings and the test of Mann-Whitney for the analysis intergroups daily pay and after-trainings, both with a level of significance of p = 0,05. The results had pointed significant increase in the muscular force of quadriceps after-training in all the trained groups, the area of transverse section of the muscle quadriceps with respect to groups GC II and GD I, of the medial vast muscle for groups GC I, GC II and GD I, and of the expository group in all the evaluated groups, except group GC I. The range of the myoelectric signal did not suffer alterations after the trainings, the medium frequencies and medium had diminished in groups GD I 45° and 90° of flexion of the joint of the knee, and in group GC II 60° of flexion of the joint of the knee, respectively. Though, we can conclude that the electric stimulation to neuromuscular revealed effective in the treatment of carriers of the patellofemoral syndrome / Mestrado / Anatomia / Mestre em Biologia Celular e Estrutural

Abstract The principal aim of a population-based cross-sectional survey was to generate information on the lifetime occurrence of prostatitis in Finnish men and their exposure to the disease, and also on the influence of prostatitis-related fears and disturbances on their sexual life. A second aim was to develop and clinically validate a new diagnostic tool for differential diagnosis between the forms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), especially between patients belonging to categories IIIA and IIIB in the new NIH (National Institutes of Health) clinical classification. Altogether 1832 men out of 2500 aged 20–59 years chosen randomly from the two most northerly provinces of Finland (Oulu and Lapland) participated in the epidemiological study, a response rate of 75%. The overall lifetime prevalence of prostatitis was 14.2%. The risk of having had the disease increased with age, being 1.7 times greater in the men aged 40–49 years than in those aged 20–39 years, and 3.1 times greater in those aged 50–59 years. More than a quarter of the 261 men who had or had had prostatitis symptoms (27%) suffered from them at least once a year, while 16% suffered from chronic prostatitis symptoms throughout the year. 63% of the men with prostatitis had their worst symptoms during the wintertime (November–march). 17% of the men with chronic prostatitis reported a constant fear of undetected prostate cancer. Erectile dysfunction was reported by 43% of the symptomatic men and decreased libido by 24%. Self-assessment of personality showed that the men with prostatitis were more often busy and nervous and had a meticulous attitude to life and problems than were the non-symptomatic men. 197 patients with chronic prostatitis/chronic pelvic pain syndrome participated in three clinical case-control studies during the years 1995–2000, at Oulu University Hospital, the District Hospital of Oulainen and Seinäjoki Central Hospital. The first prostatic tissue pressure measurement (PTPM) study included 34 patients and 9 controls. A novel method was developed to measure intraprostatic tissue pressure with a Stryker® intracompartmental pressure monitor. The PTPM showed a clear increase (p < 0.001) in the patients with symptoms of prostatitis and benign prostatic enlargement (BPE) relative to the controls and the patients with BPE but without pain symptoms. The second PTPM study included 42 patients with chronic prostatitis symptoms without significant BPE and 12 new controls. Significantly higher pressure readings (p < 0.001) were recorded at all three measurement points in the patients than in the controls. 48 new patients and 12 new controls were enrolled for the third PTPM study, the purpose of which was to confirm the results of the previous ones and to compare the prostatic tissue pressures of two clinical groups (IIIA and IIIB). The prostatic tissue pressure was again significantly higher in the patients with chronic prostatitis symptoms than in the controls (p < 0.001). An interesting finding was that prostatitis patients belonging to clinical category IIIA had significantly higher tissue pressures (p < 0.01) than those in category IIIB, probably reflecting more severe inflammation in the prostatic tissue. This new PTPM method provides a more precise and/or exact tool for differential diagnosis between the forms of pelvic pain and CP/CPPS.