Introduction: Ankle injuries are among the most prevalent acute musculoskeletal injuries, and are a significant burden on any health system. The interaction of the physiotherapist with the patient and their mutual understanding of impairments, function and recovery are important to achieving a satisfactory return to work and leisure activities. To date, little attention has focused on this interaction. There is a need for further exploration of differences and associations between outcome questionnaires that investigate similar domains of pain and function, and whether scores from such outcome measures are related to the patient’s perception of function and recovery. Of further interest is whether there are relationships between impairment measures and perceived function, and how actual performance of tasks might influence the patients understanding of their capabilities. To provide a more complete picture of these relationships, a ‘mixed methods’ approach using qualitative research methods within a quantitative study was thought to be most appropriate. The overall aim of this thesis was to utilise this research approach to investigate patients’ perceptions of their recovery and elucidate factors important to both therapists and patients that ultimately might enhance their understanding of recovery from an ankle injury. Literature reviews: Three literature reviews were undertaken. Firstly a review of systematic reviews investigating ankle sprains identified a wide variety of management strategies. There was a lack of strong evidence to support any particular management strategy. Hence clinicians are likely to have difficulty setting appropriate rehabilitation plans. Secondly a critical review identified a number of different outcome questionnaires that were utilised to gauge recovery level; however, justification for their selection was often lacking. This review also identified that little emphasis was placed on understanding the patients’ perception of their injury and the rehabilitation process. A final critical review investigated impairment and performance measures and identified four specific areas that were focused upon by clinicians during the treatment of ankle sprains: joint position sense, postural control, strength and performance during function. However, only weak evidence was found for there being a deficit in joint position sense, postural control and strength in the injured limb following an ankle sprain, and inconclusive evidence of deficits in physical performance of tasks related to function. Methods: Forty participants with an acute sprained ankle were recruited along with their treating physiotherapist. The participants completed a Global questionnaire, the Lower Limb Task Questionnaire (LLTQ) and the Short Form -36 (SF-36) Questionnaire at the initial visit, at discharge and at a six week follow up visit where they also undertook impairment testing involving, joint position sense, postural control and strength along with a functional performance test and selected functional activities. Ten participants were purposefully selected to undertake semi-structured interviews. The treating physiotherapists completed global questionnaires at the initial visit and at time of discharge. An interpretive hermeneutic approach was undertaken to examine the participants’ perceptions. Results: There were equal numbers of males and female participants and the average age of participants was 30.5 years. The relationship between questionnaires for the domains of pain and function varied between low and high degrees of association. The global limitations scores between the participants and physiotherapists were similar at the initial visit, whereas on discharge the participants had a significantly lower score (p<0.05) compared to the physiotherapists. With respect to impairment testing, there was a significant difference (p<0.05) between the uninjured limb compared to the injured limb for the joint position sense and performance agility hop test. All other comparisons of impairments were not significant (p>0.05). There was no association between questionnaire scores and impairment measures (p>0.05). Additionally there were no significant associations between previous injury and questionnaire scores and impairment measures. Finally in relation to the performance of specific functional tests there was a significant difference (p<0.05) between the six week follow up LLTQ score and the score following actual performance of the test. The findings of the participants’ interviews identified three key concerns. Firstly, that participants have a limited understanding of questionnaires, and secondly, that there is a difference in understanding of ‘recovery’ between the therapist and the patient at time of discharge. Thirdly, there was dissociation between outcome measures and the patient’s perception of their own recovery. Conclusions: This study revealed a lack of understanding and effective communication concerning physiotherapy practice in relation to ankle sprains. It was apparent that questionnaires purporting to measure similar constructs are at times dissimilar in scores and are not related strongly. Care needs to be taken in selecting and interpreting outcome measures particularly in relation to questionnaires. It was also apparent that caution should be exercised when considering the influence of impairment measures upon function. Physiotherapists should be aware that patients may perceive a lack of confidence in their level of function at the time of discharge. As a result physiotherapists need to incorporate strategies to improve patient confidence in their management plan.

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

Made available in DSpace on 2016-06-02T20:18:10Z (GMT). No. of bitstreams: 1 2334.pdf: 2125906 bytes, checksum: c4e6c6beeb6952220467b64ed76dc7d0 (MD5) Previous issue date: 2009-04-16 / Inflammation is the response of protection of the body to an aggression in order to obtain the healing. This process makes part of many diseases attended by physical therapist, however when it is increased, limits the fast recovery of the patient. High voltage pulsed current (HVPC) is one of the modalities used to interview of inflammatory process; the type of stimulation is considered monophasic pulsed that produces a high-driving voltage 150 V, but the total current (average) delivered to the tissue per second does not exceed 1.2 to 1.5mA. There are many studies that evaluate the effect of HVPC in swelling, but the major part was made in animal models and only one in human beings was found in the review of the literature. The results of the studies in animals had showed the effectiveness of HVPC in reduction of edema, but the study in human only showed clinical differences not statistically significant. Additionally, the action mechanism of HVPC is unknown and some hypotheses have been proposed for explaining its effect. The objective of this study was evaluate the effectiveness of HVPC in the inflammation process, both in humans and animals in a submotor level, 100pps of frequency and 45min of treatment. We made a controlled and randomized clinical trial in subjects with lateral sprain of ankle measuring pain, edema, range of mobility and some parameters of the gait comparing three groups: control group (CG) with standard physical therapy, HVPC(-) with standard physical therapy plus HVPC negative polarity and HVPC(+) with standard physical therapy plus HVPC positive polarity. There was not difference between the study groups, but the clinical results suggested that HVPC(-) could contribute to accelerate the recovery of inflammatory process. Second, an experimental study was done in animals evaluating pain, edema, serum histamine and albumin and the cartilage, comparing a control group, a inflammation group with HVPC(-), a inflammation group with HVPC placebo and the last group only with HVPC(-). We did not find differences between the groups in the variables, only observed the lowest cellularity in the cartilage of inflammation group+HVPC(-) and lowest optical density in inflammation group+HVPC placebo. These results are a contribution for the understanding of the biophysical agent used in the physical therapy, however is necessary more clinical studies including higher sample size, in order to demonstrate the effects of HVPC on the inflammation process. / A inflamação é uma resposta de proteção para livrar o organismo da causa da agressão e de suas conseqüências, para poder alcançar a reparação. Este processo apresenta-se em muitas das enfermidades atendidas pelos fisioterapeutas, mas às vezes sua exacerbação pode limitar a recuperação do sujeito. Uma das formas de tratamento do processo inflamatório é a estimulação elétrica de alta voltagem (EEAV). Este tipo de estimulação é caracterizada por um pulso monofásico pico duplo que gera voltagens superiores a 150V, mas com uma corrente total (média) liberada ao tecido que não excede 1,2 a 1,5mA. Vários estudos foram feitos para avaliar o efeito da EEAV no edema, mas a maioria deles foram realizados em modelos animais, sendo encontrado apenas um estudo em humanos na literatura. Os resultados dos trabalhos em animais têm mostrado a efetividade da EEAV na diminuição do edema contrastando com o estudo em humanos, o qual somente mostrou diferenças clinicas, mas não estatísticas. Adicionalmente, ainda não se conhece o mecanismo de ação da EEAV e têm sido propostas varias hipóteses para explicar este efeito. O objetivo do estudo foi determinar a efetividade da EEAV na inflamação em animais e em humanos utilizando um nível de amplitude submotor, freqüência de 100pps e 45min de tratamento. Foi feito um ensaio clínico controlado e aleatorizado em sujeitos com entorse lateral de tornozelo mensurando dor, edema, arco de mobilidade e alguns parâmetros da marcha, comparando três grupos: grupo controle (GC) com fisioterapia convencional; grupo com fisioterapia convencional mais EEAV polaridade negativa e o último grupo com fisioterapia convencional mais EEAV polaridade positiva. Não foram encontradas diferenças estatísticas entre os grupos de estudo, somente diferenças em aspectos clínicos sugerindo uma possível contribuição da EEVA com polaridade negativa na resolução do processo inflamatório. Em uma segunda etapa foi feito um estudo experimental em animais avaliando dor, edema, histamina e albumina séricas e a cartilagem. Os grupos foram: um grupo controle, um inflamado e tratado com EEAV(-), um inflamado e que recebeu EEAV placebo e mais um grupo somente tratado com EEAV(-). Não foram encontradas diferenças entre os grupos nas variáveis mensuradas, mas observou-se menor celularidade na cartilagem dos animais inflamados+EEAV(-) e menor densidade óptica no grupo inflamado+EEVA placebo. Estes resultados são uma contribuição para a validação de um agente biofísico utilizado na fisioterapia, mas precisa-se realizar mais estudos clínicos com amostras maiores para conhecer os reais efeitos da EEAV no processo inflamatório.

No description available.

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

No description available.

Significant cost and debilitation results from connective tissue injury and disease every year. Prolotherapy is an effective medical treatment used to increase joint stability. However, most associated studies are retrospective or case studies, rather than comprehensive laboratory investigation originating with the cellular response to exposure to the proliferant solutions. As a parallel consideration, nanoparticles are being investigated for use in drug delivery and heat shock treatment of cancerous tissue due to their unique structural and thermal properties. The phenomenal strength and stiffness of carbon nanoparticles have been used for commercial purposes in composite materials, but investigation of biomedical applications is still fairly nascent. In an attempt to develop a non-surgical approach to supporting and healing damaged ligaments and tendons resulting from injury or disease by combining prolotherapy and the use of nanoparticles, the author presents studies investigating the cellular response to proliferative therapy solution as well as tendon and ligament tissue's mechanical and cellular response to exposure to nanoparticles. In the prolotherapy solution cell studies, the results suggested that there is an optimal dosage of the proliferant for in vitro studies, different responses between cell types, and a dosage-dependent response in cell viability and collagen production to the solution P2G in preosteoblasts. In the nanoparticle studies, cell populations tolerated nanoparticles at the levels tested, tendon mechanical properties were increased (stiffness significantly so), and bright field and transmission electron microscopic histological images were taken of connective tissue and carbon nanohorn interactions. / Master of Science

As lesões de tornozelo, mais precisamente na articulação subtalar, chamadas de entorses, estão bastante presentes no âmbito esportivo. No futsal, esporte amplamente praticado em nosso país, a entorse por inversão do tornozelo está entre as lesões que mais acometem os atletas em todos os níveis de sua prática devido às exigências que o esporte impõe. Avaliações isocinéticas têm sido utilizadas na medição de performances musculares com o intuído de se obterem dados mais precisos em relação às forças produzidas por diferentes grupos musculares. A razão de torque e ativação são duas variáveis que podem ser medidas nestes testes servindo como parâmetro para detectar possíveis desequilíbrios musculares entre músculos agonistas/antagonistas. Este trabalho buscou avaliar as razões de torque e ativação, bem como a potência e o trabalho musculares realizados pela musculatura eversora e inversora do tornozelo em atletas de uma equipe de futsal. Foram avaliados 13 atletas, dos quais 7 atletas com lesão unilateral de tornozelo serviram de amostra para uma comparação entre o membro lesado e não lesado. As razões de torque e ativação da musculatura eversora e inversora do tornozelo foram avaliadas durante contrações isométricas voluntárias máximas nos ângulos de -20º de inversão, 0º e 20º de eversão, e isocinéticas concêntricas e excêntricas nas velocidades de 60º, 120º e 180º/s. As variáveis de trabalho e potência também foram obtidas nestes testes. As razões de torque foram obtidas com a divisão dos valores do pico de torque eversor pelo pico de torque inversor, e as razões de ativação da mesma forma, porém dividindo o valor RMS do sinal EMG dos músculos eversores Fibular Curto e Fibular Longo pelo músculo inversor Tibial Anterior. Os valores encontrados nas razões de torque convencionais e funcionais não demonstraram diferenças significativas entre o grupo de tornozelos com e sem lesão, com exceção da razão funcional inversora EVexc/INVcon, na qual foram encontrados valores maiores no grupo lesado, o que indica possível desequilíbrio na relação Ev/Inv. As razões de ativação não mostraram diferenças significativas entre os dois grupos. Já as variáveis trabalho e potência foram equivalentes nos dois grupos, o que demonstra que após a lesão e a recuperação destes atletas, e com a volta as atividades esportivas houve um reestabelecimento na produção das forças musculares que atuam na musculatura eversora e inversora do tornozelo. / The ankle injuries, more precisely in "subtalar" joint, called sprains, are very present at the sportive universe. In the indoor soccer, commonly practiced in our country, the sprains by the ankle inversion is between the injuries that happens more for the athletes at all levels of the practice because of the requirements imposed by the sport. Isokinetic evaluations have been used in the medication of muscular performance with the intention of getting more precise data about the strength produced by different muscular groups. The torque and activation ratios are two variables that can be measured in these tests, serving as parameter to detect possible muscular unbalance between agonist/antagonist muscles. This paper sought to evaluate the torque and activation ratios, and the power and muscular work done by the evertor and invertor ankle musculature, in indoor soccer players as well. Thirteen athletes were evaluated, seven of them that have unilateral ankle injury, were used to compare the injured and the healthy member. The torque and activation ratios at the evertor and invertor ankle musculature were evaluated during maximum voluntary isometrics contractions at the angles of -20º inversion, 0o and 20º eversion, and concentric and eccentric isokinetics at the velocities of 60º 120º and 180º/s. The work and power variables were also obtained in this tests. The torque ratio were obtained by dividing the evertor torque peak by the invertor torque peak, and the activation ratio by the same way, but dividing the RMS value by the EMG signal from the Short and Long Fibular Muscles Evertor by the Previous Tibial Muscle Invertor. The values found at the conventional and functional torque ratios, not showed significant differences between injured and health ankles, except for the invertor functional ratio EVexc/INVcon, which we found bigger values at the injured group, and this points for an unbalance at the Ev/Inv relation. The activation ratio not showed significant difference between the groups. But the power and work variables were equivalents in both groups, which demonstrate that after these athletes injures and the recuperations, and with the returning to the sportive activities, there were an reestablishing at the production of the muscular strength that actuate in the evertor and invetor ankle musculature.

As lesões de tornozelo, mais precisamente na articulação subtalar, chamadas de entorses, estão bastante presentes no âmbito esportivo. No futsal, esporte amplamente praticado em nosso país, a entorse por inversão do tornozelo está entre as lesões que mais acometem os atletas em todos os níveis de sua prática devido às exigências que o esporte impõe. Avaliações isocinéticas têm sido utilizadas na medição de performances musculares com o intuído de se obterem dados mais precisos em relação às forças produzidas por diferentes grupos musculares. A razão de torque e ativação são duas variáveis que podem ser medidas nestes testes servindo como parâmetro para detectar possíveis desequilíbrios musculares entre músculos agonistas/antagonistas. Este trabalho buscou avaliar as razões de torque e ativação, bem como a potência e o trabalho musculares realizados pela musculatura eversora e inversora do tornozelo em atletas de uma equipe de futsal. Foram avaliados 13 atletas, dos quais 7 atletas com lesão unilateral de tornozelo serviram de amostra para uma comparação entre o membro lesado e não lesado. As razões de torque e ativação da musculatura eversora e inversora do tornozelo foram avaliadas durante contrações isométricas voluntárias máximas nos ângulos de -20º de inversão, 0º e 20º de eversão, e isocinéticas concêntricas e excêntricas nas velocidades de 60º, 120º e 180º/s. As variáveis de trabalho e potência também foram obtidas nestes testes. As razões de torque foram obtidas com a divisão dos valores do pico de torque eversor pelo pico de torque inversor, e as razões de ativação da mesma forma, porém dividindo o valor RMS do sinal EMG dos músculos eversores Fibular Curto e Fibular Longo pelo músculo inversor Tibial Anterior. Os valores encontrados nas razões de torque convencionais e funcionais não demonstraram diferenças significativas entre o grupo de tornozelos com e sem lesão, com exceção da razão funcional inversora EVexc/INVcon, na qual foram encontrados valores maiores no grupo lesado, o que indica possível desequilíbrio na relação Ev/Inv. As razões de ativação não mostraram diferenças significativas entre os dois grupos. Já as variáveis trabalho e potência foram equivalentes nos dois grupos, o que demonstra que após a lesão e a recuperação destes atletas, e com a volta as atividades esportivas houve um reestabelecimento na produção das forças musculares que atuam na musculatura eversora e inversora do tornozelo. / The ankle injuries, more precisely in "subtalar" joint, called sprains, are very present at the sportive universe. In the indoor soccer, commonly practiced in our country, the sprains by the ankle inversion is between the injuries that happens more for the athletes at all levels of the practice because of the requirements imposed by the sport. Isokinetic evaluations have been used in the medication of muscular performance with the intention of getting more precise data about the strength produced by different muscular groups. The torque and activation ratios are two variables that can be measured in these tests, serving as parameter to detect possible muscular unbalance between agonist/antagonist muscles. This paper sought to evaluate the torque and activation ratios, and the power and muscular work done by the evertor and invertor ankle musculature, in indoor soccer players as well. Thirteen athletes were evaluated, seven of them that have unilateral ankle injury, were used to compare the injured and the healthy member. The torque and activation ratios at the evertor and invertor ankle musculature were evaluated during maximum voluntary isometrics contractions at the angles of -20º inversion, 0o and 20º eversion, and concentric and eccentric isokinetics at the velocities of 60º 120º and 180º/s. The work and power variables were also obtained in this tests. The torque ratio were obtained by dividing the evertor torque peak by the invertor torque peak, and the activation ratio by the same way, but dividing the RMS value by the EMG signal from the Short and Long Fibular Muscles Evertor by the Previous Tibial Muscle Invertor. The values found at the conventional and functional torque ratios, not showed significant differences between injured and health ankles, except for the invertor functional ratio EVexc/INVcon, which we found bigger values at the injured group, and this points for an unbalance at the Ev/Inv relation. The activation ratio not showed significant difference between the groups. But the power and work variables were equivalents in both groups, which demonstrate that after these athletes injures and the recuperations, and with the returning to the sportive activities, there were an reestablishing at the production of the muscular strength that actuate in the evertor and invetor ankle musculature.

As lesões de tornozelo, mais precisamente na articulação subtalar, chamadas de entorses, estão bastante presentes no âmbito esportivo. No futsal, esporte amplamente praticado em nosso país, a entorse por inversão do tornozelo está entre as lesões que mais acometem os atletas em todos os níveis de sua prática devido às exigências que o esporte impõe. Avaliações isocinéticas têm sido utilizadas na medição de performances musculares com o intuído de se obterem dados mais precisos em relação às forças produzidas por diferentes grupos musculares. A razão de torque e ativação são duas variáveis que podem ser medidas nestes testes servindo como parâmetro para detectar possíveis desequilíbrios musculares entre músculos agonistas/antagonistas. Este trabalho buscou avaliar as razões de torque e ativação, bem como a potência e o trabalho musculares realizados pela musculatura eversora e inversora do tornozelo em atletas de uma equipe de futsal. Foram avaliados 13 atletas, dos quais 7 atletas com lesão unilateral de tornozelo serviram de amostra para uma comparação entre o membro lesado e não lesado. As razões de torque e ativação da musculatura eversora e inversora do tornozelo foram avaliadas durante contrações isométricas voluntárias máximas nos ângulos de -20º de inversão, 0º e 20º de eversão, e isocinéticas concêntricas e excêntricas nas velocidades de 60º, 120º e 180º/s. As variáveis de trabalho e potência também foram obtidas nestes testes. As razões de torque foram obtidas com a divisão dos valores do pico de torque eversor pelo pico de torque inversor, e as razões de ativação da mesma forma, porém dividindo o valor RMS do sinal EMG dos músculos eversores Fibular Curto e Fibular Longo pelo músculo inversor Tibial Anterior. Os valores encontrados nas razões de torque convencionais e funcionais não demonstraram diferenças significativas entre o grupo de tornozelos com e sem lesão, com exceção da razão funcional inversora EVexc/INVcon, na qual foram encontrados valores maiores no grupo lesado, o que indica possível desequilíbrio na relação Ev/Inv. As razões de ativação não mostraram diferenças significativas entre os dois grupos. Já as variáveis trabalho e potência foram equivalentes nos dois grupos, o que demonstra que após a lesão e a recuperação destes atletas, e com a volta as atividades esportivas houve um reestabelecimento na produção das forças musculares que atuam na musculatura eversora e inversora do tornozelo. / The ankle injuries, more precisely in "subtalar" joint, called sprains, are very present at the sportive universe. In the indoor soccer, commonly practiced in our country, the sprains by the ankle inversion is between the injuries that happens more for the athletes at all levels of the practice because of the requirements imposed by the sport. Isokinetic evaluations have been used in the medication of muscular performance with the intention of getting more precise data about the strength produced by different muscular groups. The torque and activation ratios are two variables that can be measured in these tests, serving as parameter to detect possible muscular unbalance between agonist/antagonist muscles. This paper sought to evaluate the torque and activation ratios, and the power and muscular work done by the evertor and invertor ankle musculature, in indoor soccer players as well. Thirteen athletes were evaluated, seven of them that have unilateral ankle injury, were used to compare the injured and the healthy member. The torque and activation ratios at the evertor and invertor ankle musculature were evaluated during maximum voluntary isometrics contractions at the angles of -20º inversion, 0o and 20º eversion, and concentric and eccentric isokinetics at the velocities of 60º 120º and 180º/s. The work and power variables were also obtained in this tests. The torque ratio were obtained by dividing the evertor torque peak by the invertor torque peak, and the activation ratio by the same way, but dividing the RMS value by the EMG signal from the Short and Long Fibular Muscles Evertor by the Previous Tibial Muscle Invertor. The values found at the conventional and functional torque ratios, not showed significant differences between injured and health ankles, except for the invertor functional ratio EVexc/INVcon, which we found bigger values at the injured group, and this points for an unbalance at the Ev/Inv relation. The activation ratio not showed significant difference between the groups. But the power and work variables were equivalents in both groups, which demonstrate that after these athletes injures and the recuperations, and with the returning to the sportive activities, there were an reestablishing at the production of the muscular strength that actuate in the evertor and invetor ankle musculature.