Does early mobilisation after surgical repair of rotator cuff tears improve biomechanical and clinical outcomes?

The number of rotator cuff repairs performed in the UK and worldwide is increasing every year. However, there are still controversies regarding when rehabilitation after surgery should start. Therefore, the aim of this thesis was to investigate the effectiveness of early rehabilitation compared to conservative after rotator cuff repairs. First, a systematic review was performed to critically analyse and discuss the current literature. The systematic review demonstrated that early rehabilitation may be beneficial to improve ROM but not function; however, due to high risk of bias of existing primary studies further RCTs are still needed for consensus. Based on the systematic review findings an RCT was planned. The aim of the trial was to assess and to compare clinical and biomechanical outcomes of patients who were allocated to early or conservative rehabilitation after rotator cuff repairs. The objectives of the RCT were: to compare and to detail EMG and kinematic changes that occur during the rehabilitation period between groups, and to compare how much residual impairment patients still show after 6 months of surgery in comparison to a normal population. Ninety-nine patients were screened for inclusion, and 42 patients agreed to participate and had a baseline biomechanics assessment. Twenty-two patients who had the initial biomechanics assessment were excluded from the trial because they did not fit the inclusion criteria based on surgical requirements. Twenty patients were randomised to treatment with 10 in each group. The biomechanics assessments were performed before surgery and after 3 and 6 months. 3D kinematics and EMG activity of 5 muscles (upper trapezius, anterior deltoid, medium deltoid, posterior deltoid and biceps brachii) from six movement tasks. In addition, the Oxford Shoulder Score and EQ-5D-5L were also recorded. Overall, no differences were found between the Early and Conservative groups for biomechanical and clinical outcomes. However, at 6 months the post-operative patients in the Early group had better ROM than those in the Conservative group. A further exploration of the data indicated that at 3 months patients who responded to treatment were those who used the sling for a shorter number of hours per day, independent of which group they were allocated to, had fewer surgical procedures and a shorter period between first symptoms and surgery. The data from the 22 patients who underwent the initial assessment but did not meet the inclusion criteria were used in a third study to explore whether the biomechanics assessment used in the trial was capable of discriminating patients with different levels of tissue damage and therefore potentially support surgery planning. The discriminant analysis showed an accuracy of 91.9% of correct classification based on the tasks proposed. In conclusion, early rehabilitation does not seem to improve outcomes more than a conservative protocol, although the amount of sling usage appears to be an important factor in recovery. The conclusions of the RCT must be considered carefully due to limitations. The RCT of this thesis was the first on the topic to use biomechanics to detail how patients progress from pre-surgery until 6 months post-surgery, therefore contributing to a thorough understanding of patients’ rehabilitation and recovery processes. In addition, the method of assessment proposed showed important discriminatory capacity, which can aid surgery planning by identifying different movement patterns

Determination of the motor unit behavior of lumbar erector spinae muscles through surface EMG decomposition technology in healthy female subjects

Introduction: The aims of this study were to determine the motor unit behavior of the erector spinae muscles and to assess whether differences exist between the dominant/non-dominant sides of the back muscles. Methods: Nine healthy women, aged 21.7 years (±0.7), performed a back extension test. Surface electromyographic decomposition data were collected from both sides of the erector spinae and decomposed into individual motor unit action potential trains. The mean firing rate for each motor unit was calculated, and a regression analysis was performed against the corresponding recruitment thresholds. Results: The mean firing rate ranged from 15.9 to 23.9 pulses per second (pps) and 15.8 to 20.6 pps on the dominant and non-dominant sides, respectively. However, the early motor unit potential s of the non-dominant lumbar erector spinae muscles were recruited at a lower firing rate. Conclusions: This technique may further our understanding of individuals with back pain and other underlying neuromuscular diseases

Evaluación isocinética de los músculos de la rodilla en jugadores de fútbol : análisis discriminante

Introdução: a atividade muscular em jogadores de futebol pode ser medida por meio do dinamômetro isocinético, que é um instrumento confiável para avaliação do desempenho humano. Objetivos: conduzir análises isocinéticas e discriminar quais variáveis diferenciam a categoria sub-17 (S17) da profissional (PRO).Métodos:Trinta e quatro jogadores de futebol (n=17 para cada categoria) foram avaliados. As variáveis isocinéticas utilizadas para a análise de extensão-flexão do joelho foram: pico de torque (Nm), trabalho total (J), potência média (W), ângulo de pico de torque (graus), razão agonista/antagonista (%), testadas em três velocidades (60°/s, 120°/s e 300°/s), com cada série contendo cinco repetições. Três análises discriminantes foram feitas usando o método Wilk's Lambda para identificar quais variáveis fariam uma discriminação significativa entre as duas categorias. Resultados: as variáveis discriminantes a 60°/s na categoria PRO foram: pico de torque extensores, trabalho total flexores, potência média de extensores e razão agonista/antagonista; e para os S17 foram: trabalho total de extensores, pico de torque de flexores e potência média de flexores. A 120°/s para a categoria PRO as variáveis discriminantes foram: pico de torque de flexores e potência média de extensores; para os S17 foram: trabalho total de extensores e potência média de flexores. A 300°/s, as variáveis encontradas para as categorias PRO e S17 foram, respectivamente: potência média de extensores e trabalho total de extensores. Conclusão: as variáveis isocinéticas para os músculos do joelho flexores e extensores foram capazes de fazer uma discriminação significativa entre jogadores de futebol PRO e S17.Introduction: muscle activity in soccer players can be measured by isokinetic dynamometer, which is a reliable tool for assessing human performance. Objectives: to perform isokinetic analyses and to determine which variables differentiate the under-17 (U17) soccer category from the professional (PRO). Methods: thirty four players were assessed (n=17 for each category). The isokinetic variables used for the knee extension-flexion analysis were: peak torque (Nm), total work (J), average power (W), angle of peak torque (deg.), agonist/ antagonist ratio (%), measured for three velocities (60°/s, 120°/s and 300°/s), with each series containing five repetitions. Three Wilks' Lambda discriminant analyses were performed, to identify which variables were more significant for the definition of each of the categories. Results: the discriminative variables at 60°/s in the PRO category were: extension peak torque, flexion total work, extension average power and agonist/antagonist ratio; and for the U17s were: extension total work, flexion peak torque and flexion average power. At 120°/s for the PRO category the discriminant variables were: flexion peak torque and extension average power; for the U17s they were: extension total work and flexion average power. Finally at 300°/s, the variables found in the PRO and U17 categories respectively were: extension average power and extension total work. Conclusion: isokinetic variables for flexion and extension knee muscles were able to significantly discriminate between PRO and U17 soccer players.Introducción: la actividad muscular en jugadores de fútbol puede ser medida por medio del dinamómetro isocinético, que es un instrumento confiable para evaluación del desempeño humano. Objetivos: conducir análisis isocinéticos y discriminar qué variables diferencian la categoría sub-17 (S17) de la profesional (PRO). Métodos: fueron evaluados treinta y cuatro jugadores de fútbol (n=17 para cada categoría). Las variables isocinéticas utilizadas para el análisis de extensión-flexión de la rodilla fueron: pico de torque (Nm), trabajo total (J), potencia media (W), ángulo de pico de torque (grados), razón agonista/antagonista (%), probadas en tres velocidades (60°/s, 120°/s y 300°/s), con cada serie conteniendo cinco repeticiones. Fueron realizados tres análisis discriminantes usando el método Wilk's Lambda para identificar qué variables harían una discriminación significativa entre las dos categorías. Resultados: las variables discriminantes a 60°/s en la categoría PRO fueron: pico de torque extensores, trabajo total flexores, potencia media de extensores y razón agonista/antagonista; y para los S17 fueron: trabajo total de extensores, pico de torque de flexores y potencia media de flexores. A 120°/s para la categoría PRO las variables discriminantes fueron: pico de torque de flexores y potencia media de extensores; para los S17 fueron: trabajo total de extensores y potencia media de flexores. A 300°/s, las variables encontradas para las categorías PRO y S17 fueron, respectivamente: potencia media de extensores y trabajo total de extensores. Conclusión: las variables isocinéticas para los músculos de la rodilla flexores y extensores fueron capaces de hacer una discriminación significativa entre jugadores de fútbol PRO y S17

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

Aim/objective The aim is to critically analyse and discuss the current literature and determine the effectiveness of ehabilitation for patients after surgical repair of rotator cuff tears for range of motion (ROM), pain, functional status and retear rates; in addition, an update of new literature is included. Design Overview of systematic reviews. Data sources A search was performed with no restrictions to date of publication and language in the following databases: EBSCO, AMED, CINAHL, SPORTDiscus, EMBASE, Cochrane, LILACS, MEDLINE, PEDro, Scielo, SCOPUS and Web of Knowledge. The PRISMA guideline was followed to develop this review and the R-AMSTAR tool was used for critical appraisal of included reviews. Eligibility criteria Only systematic reviews and randomised controlled trials (RCTs) comparing the effectiveness of early with conservative rehabilitation, after surgical repair of the rotator cuff, were included. Moreover, the studies should report ROM, pain, functional status and/or retears rates before and after 3–24 months of the surgery. Results 10 systematic reviews and 11 RCTs were included for the final analysis. Conflicting results and conclusions were presented by the systematic reviews, the use of primary studies varied; also the methodological quality of the reviews was diverse. This updated review, with new meta-analysis, showed no difference for function, pain, ROM or retears ratio between early and conservative rehabilitation. Summary/Conclusions Early mobilisation may be beneficial, particularly for small and medium tears; however, more studies with higher quality are required, especially for patients with large tears who have been given less attention

Isokinetic evaluation of knee muscles in soccer players: discriminant analysis [Avaliação isocinética dos músculos do joelho em jogadores de futebol: análise discriminante]; [Evaluación isocinética de los músculos de la rodilla en jugadores de fútbol: análisis discriminante]

Introduction: Muscle activity in soccer players can be measured by isokinetic dynamometer, which is a reliable tool for assessing human performance. Objectives: To perform isokinetic analyses and to determine which variables differentiate the under-17 (U17) soccer category from the professional (PRO). Methods: Thirty four players were assessed (n=17 for each category). The isokinetic variables used for the knee extension-flexion analysis were: peak torque (Nm), total work (J), average power (W), angle of peak torque (deg.), agonist/ antagonist ratio (%), measured for three velocities (60°/s, 120°/s and 300°/s), with each series containing five repetitions. Three Wilks' Lambda discriminant analyses were performed, to identify which variables were more significant for the definition of each of the categories. Results: The discriminative variables at 60°/s in the PRO category were: extension peak torque, flexion total work, extension average power and agonist/antagonist ratio; and for the U17s were: extension total work, flexion peak torque and flexion average power. At 120°/s for the PRO category the discriminant variables were: flexion peak torque and extension average power; for the U17s they were: extension total work and flexion average power. Finally at 300°/s, the variables found in the PRO and U17 categories respectively were: extension average power and extension total work. Conclusion: Isokinetic variables for flexion and extension knee muscles were able to significantly discriminate between PRO and U17 soccer players. RESUMO Introdução: A atividade muscular em jogadores de futebol pode ser medida por meio do dinamômetro isocinético, que é um instrumento confiável para avaliação do desempenho humano. Objetivos: Conduzir análises isocinéticas e discriminar quais variáveis diferenciam a categoria sub-17 (S17) da profissional (PRO). Métodos: Trinta e quatro jogadores de futebol (n=17 para cada categoria) foram avaliados. As variáveis isocinéticas utilizadas para a análise de extensão-flexão do joelho foram: pico de torque (Nm), trabalho total (J), potência média (W), ângulo de pico de torque (graus), razão agonista/antagonista (%), testadas em três velocidades (60°/s, 120°/s e 300°/s), com cada série contendo cinco repetições. Três análises discriminantes foram feitas usando o método Wilk's Lambda para identificar quais variáveis fariam uma discriminação significativa entre as duas categorias. Resultados: As variáveis discriminantes a 60°/s na categoria PRO foram: pico de torque extensores, trabalho total flexores, potência média de extensores e razão agonista/antagonista; e para os S17 foram: trabalho total de extensores, pico de torque de flexores e potência média de flexores. A 120°/s para a categoria PRO as variáveis discriminantes foram: pico de torque de flexores e potência média de extensores; para os S17 foram: trabalho total de extensores e potência média de flexores. A 300°/s, as variáveis encontradas para as categorias PRO e S17 foram, respectivamente: potência média de extensores e trabalho total de extensores. Conclusão: As variáveis isocinéticas para os músculos do joelho flexores e extensores foram capazes de fazer uma discriminação significativa entre jogadores de futebol PRO e S17. RESUMEN Introducción: La actividad muscular en jugadores de fútbol puede ser medida por medio del dinamómetro isocinético, que es un instrumento confiable para evaluación del desempeño humano. Objetivos: Conducir análisis isocinéticos y discriminar qué variables diferencian la categoría sub-17 (S17) de la profesional (PRO). Métodos: Fueron evaluados treinta y cuatro jugadores de fútbol (n=17 para cada categoría). Las variables isocinéticas utilizadas para el análisis de extensión-flexión de la rodilla fueron: pico de torque (Nm), trabajo total (J), potencia media (W), ángulo de pico de torque (grados), razón agonista/antagonista (%), probadas en tres velocidades (60°/s, 120°/s y 300°/s), con cada serie conteniendo cinco repeticiones. Fueron realizados tres análisis discriminantes usando el método Wilk's Lambda para identificar qué variables harían una discriminación significativa entre las dos categorías. Resultados: Las variables discriminantes a 60°/s en la categoría PRO fueron: pico de torque extensores, trabajo total flexores, potencia media de extensores y razón agonista/antagonista; y para los S17 fueron: trabajo total de extensores, pico de torque de flexores y potencia media de flexores. A 120°/s para la categoría PRO las variables discriminantes fueron: pico de torque de flexores y potencia media de extensores; para los S17 fueron: trabajo total de extensores y potencia media de flexores. A 300°/s, las variables encontradas para las categorías PRO y S17 fueron, respectivamente: potencia media de extensores y trabajo total de extensores. Conclusión: Las variables isocinéticas para los músculos de la rodilla flexores y extensores fueron capaces de hacer una discriminación significativa entre jugadores de fútbol PRO y S17

Can shoulder impairments be classified from three-dimensional kinematics using inertial sensors?

Background: Magnetic Resonance Imaging and ultrasound imaging are often used for clinical decision making to confirm diagnosis and plan treatment in shoulder problems, but this can be costly and reporting the findings can take time. The aim was to determine whether range of shoulder motion during movement tasks measured using inertial sensors are capable of accurately discriminating between patients with different shoulder problems. Methods: Inertial sensors were used to measure three-dimensional shoulder motion during six tasks of 37 patients on the waiting list for shoulder surgery. Discriminant analysis was used to identify whether the range of motion of different tasks could classify patients with different shoulder problems. Results: The discriminant analysis could correctly classify 91.9% of patients into one of the three diagnostic groups based. The tasks that associated a patient with a particular diagnostic group were: subacromial decompression: abduction; rotator cuff repair with tears ≤5 cm: flexion and rotator cuff repair with tears > 5 cm: combing hair, abduction and horizontal abduction-adduction. Conclusions: The discriminant analysis showed that range of motion measured by inertial sensors can correctly classify patients and could be used as a screening tool to support surgery planning

Análise comparativa da atividade elétrica do músculo multífido durante exercícios do Pilates, série de Williams e Spine Stabilization

Introdução: A fraqueza da musculatura paraespinhal está relacionada à etiologia da dor lombar. Atualmente existem vários métodos que apresentam exercícios para o fortalecimento dessa musculatura. Objetivos: Comparare analisar o sinal eletromiográfico do músculo multífido bilateralmente durante exercícios do método Pilates, série de Williams e Spine Stabilization. Materiais e métodos: Participaram do estudo dez mulheres voluntárias e saudáveis que realizaram os exercícios leg pull front support modificado do Pilates, o quarto exercício da série adicional de Williams e o quadruped exercise do Spine Stabilization. O sinal foi normalizado pelo pico eletromiográfico da atividade dinâmica e foram ajustados para 2000 amostras por segundo e o filtro em uma frequência de passagem de 20 a 450 Hz. A ANOVA foi utilizada para verificar diferenças entre os exercícios, o teste t para amostras dependentes foi usado para comparar a ativação entre os lados direito e esquerdo do multífido para cada exercício. Resultados e considerações finais: Na comparação entre os exercícios, observaram-se diferenças significativas para o músculo multífido a favor do exercício do método Pilates tanto na fase concêntrica quanto na excêntrica, o que demonstra ser o exercício de melhor ativação elétrica para o músculo analisado

Análise comparativa da atividade elétrica do músculo multífido durante exercícios do Pilates, série de Williams e Spine Stabilization

INTRODUÇÃO: A fraqueza da musculatura paraespinhal está relacionada à etiologia da dor lombar. Atualmente existem vários métodos que apresentam exercícios para o fortalecimento dessa musculatura. OBJETIVOS: Comparar e analisar o sinal eletromiográfico do músculo multífido bilateralmente durante exercícios do método Pilates, série de Williams e Spine Stabilization. MATERIAIS E MÉTODOS: Participaram do estudo dez mulheres voluntárias e saudáveis que realizaram os exercícios leg pull front support modificado do Pilates, o quarto exercício da série adicional de Williams e o quadruped exercise do Spine Stabilization. O sinal foi normalizado pelo pico eletromiográfico da atividade dinâmica e foram ajustados para 2000 amostras por segundo e o filtro em uma frequência de passagem de 20 a 450 Hz. A ANOVA foi utilizada para verificar diferenças entre os exercícios, o teste t para amostras dependentes foi usado para comparar a ativação entre os lados direito e esquerdo do multífido para cada exercício. RESULTADOS E CONSIDERAÇÕES FINAIS: Na comparação entre os exercícios, observaram-se diferenças significativas para o músculo multífido a favor do exercício do método Pilates tanto na fase concêntrica quanto na excêntrica, o que demonstra ser o exercício de melhor ativação elétrica para o músculo analisado

Effect of the Pilates method on physical conditioning of healthy subjects: A systematic review and meta-analysis

INTRODUCTION: Physical conditioning consists of a variety of health-related attributes and Pilates exercises are described as a form of this conditioning. The objective of this systematic review was to determine the effect of the Pilates method on health and ability outcome of the physical conditioning of healthy individuals. EVIDENCE ACQUISITION: The search was performed in the following databases: Medline, Cinahl, Embase, Lilacs, Scielo, Web of Science, PEDro, Cochrane Controlled Trials Register Library, Scopus, Science Direct and Google Scholar. (1950-2014). Included studies were randomized controlled trials (RCTs) that assessed the effects of the Pilates method on healthy subjects. EVIDENCE SYNTHESIS: Nine RCTs met the inclusion criteria. Pilates improved abdominal muscular endurance when compared with no exercises (mean difference [MD]=9.53%; 95% CI: 2.41, 16.43; P=0.009), however, there was no difference in flexibility (MD=4.97; 95% CI: -0.53, 10.47; P=0.08). Some positive effects (up to 6 months) of the Pilates practice were found in some RCTs' results as follows: Improvement of dynamic balance, quality of life and back muscle flexibility. CONCLUSIONS: The results indicate the Pilates exercises performed on the mat or apparatus 2 to 3 times a week, for 5 to 12 weeks, improves abdominal muscular endurance (on average, 10 more abdominals curls in 1-minute sit-up test) for both genders, when compared to no exercises