Comment concilier recherche de performance sportive et prévention des accidents tendino-musculaires ?

L’équilibre musculaire agonistes/antagonistes est un élément essentiel de la stabilité articulaire et du fonctionnement moteur. La pratique sportive s’accompagne souvent de perturbations de cet équilibre, à l’origine de lésions musculo-tendineuses. L’objectif des thérapeutes et des préparateurs physiques est de préserver cette balance musculaire sans compromettre la performance sportive. Le ratio fonctionnel, établi en isocinétisme, antagonistes en excentrique/agonistes en concentrique doit guider les actions curatives et l’entraînement. Le compromis le plus acceptable est la réalisation d’un renforcement global intéressant les agonistes et les antagonistes en concentrique associaé` un renforcement spécifique des antagonistes en excentrique. À ce jour il n’est pas possible de savoir si le déséquilibre musculaire est un élément déterminant de la performance ou simplement une conséquence potentiellement délétère de l’entraînement et des études complémentaires sont nécessaires pour répondre à ces questions

Validation d'un indice d'évaluation fonctionnelle de l'épaule (l'indice fonctionnel uniformisé (IFU))

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Isokinetic shoulder rotator muscles in wheelchair athletes

International audienceObjectives: To assess the influence of wheelchair propulsion and neurological level on isokinetic shoulder rotational strength. Setting: University of Montpellier, France Methods: Data were evaluated in three groups of subjects as follows: 12 nonathletes, 15 tennis players and 21 wheelchair athletes. We then compared 12 high paraplegic athletes (HPA) and nine low paraplegic athletes (LPA) within the group of 21 wheelchair athletes: The isokinetic tests were performed in the seated 451 abducted test position in the scapular plane at 60, 180 and 3001 s À1 for both shoulders. Peak torque and mean power values were gathered and, from these values, the internal/external rotation ratios were calculated. Results: Intergroup comparison showed an influence of lesion and sport on peak torque at 180 and 3001 s À1 for the internal rotators and significantly higher values of the internal/external ratios in the wheelchair athlete group. For mean power, we observed significant differences under all test conditions and significant differences for ratio only on the dominant side at 1801 s À1 and on the dominant side at 3001 s À1. Comparison of the two groups of paraplegic athletes showed significantly higher values of peak torque and mean power of the external rotators in the LPA for all test conditions. Conclusions: Neurological level of lesion does not systematically influence the development of internal rotator muscles; in contrast, the participation of the external rotators appears strongly correlated to neurological level. The comparison of the two sides in the two paraplegic groups showed that in two-thirds of the cases the values of the external rotators were significantly higher than those of the internal rotators on the nondominant side for peak torque and mean power. Ratios on the dominant side were systematically higher than on the nondominant side, with significant differences also noted in two-thirds of the cases. These results raise questions about the influence of neurological level and wheelchair propulsion on the muscular adaptations of the shoulder in wheelchair athletes

Effets d'une technique de recentrage articulaire de la tête humérale sur la force et l'amplitude des rotations de l'épaule

Etude des effets d'une technique de réharmonisation articulaire de l'articulation gléno-humérale selon Sohier sur l'amplitude passive des rotations et la force maximale des rotateurs chez des joueuses de handball professionnelles, présentant toutes un décentrage antéro-supérieur

Évaluation et rééducation des muscles de l'épaule en isocinétisme : méthodologie, résultats et applications

International audienceObjectifs.-Préciser, à partir d'une revue de la littérature, l'apport de l'isocinétisme dans l'évaluation et la rééducation de l'épaule. Méthode.-La revue de la littérature a porté sur les publications en langues anglaise et française, recueillies à partir de la banque de données Medline, des références des articles ainsi colligés ce qui a permis l'analyse de publications non indexées. Quatre-vingt-sept articles présentant un intérêt direct pour cette étude ont été retenus. Résultat.-La validité de l'évaluation isocinétique de l'épaule est bonne. La reproductibilité, bien qu'inférieure à celle du genou, est satisfaisante sous réserve d'une méthodologie de test rigoureuse. Les valeurs normales, pour les rotateurs, les abducteurs-adducteurs et extenseurs-fléchisseurs sont dépendantes de divers paramètres tels que l'âge, le sexe, la corpulence, l'activité physique pratiquée. Le calcul des ratios agonistes-antagonistes est surtout intéressant en pathologie. Dans le conflit sous-acromial et l'instabilité de l'épaule est constamment observée une modification du ratio des rotateurs, qui apparaît plus comme un agent causal que comme une conséquence de l'affection. Cette modification perdure habituellement après traitement chirurgical de ces atteintes et la normalisation des ratios doit constituer un des éléments de la rééducation postopératoire. Conclusion.-L'isocinétisme constitue une méthode de référence en matière d'évaluation de la force musculaire, permettant de détecter les déficits portant sur certains groupes et plus encore les perturbations de la balance agonistes-antagonistes constatées lors de certaines pathologies d'épaule. Il constitue une aide précieuse à la rééducation en orientant la prise en charge préférentiellement sur les groupes déficitaires, en complétant les techniques de renforcement classiques et en permettant un suivi précis des progrès accomplis

Reliability of shoulder rotators isokinetic strength imbalance measured using the Biodex dynamometer.

International audienceBACKGROUND: Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance and to guide rehabilitation. The reliability of isokinetic assessment is fundamental to track small but clinically relevant changes. OBJECTIVES: We aimed to analyze the absolute and relative reliability of strength imbalance indices such as peak torque ratios (ERconc/IRconc, ERecc/IRecc, ERecc/IRcon, IRecc/ERcon), bilateral concentric and eccentric strength ratios, and to examine the reliability of external rotator and internal rotator peak torque measured using a Biodex(®) dynamometer in the seated position. DESIGN: Cross-sectional laboratory study. METHODS: Forty-six healthy participants were tested twice with seven days between sessions, at 60°/s and 120°/s concentrically, and 30°/s eccentrically. RESULTS: Low to moderate relative reliability (intraclass correlation coefficient: 0.25-0.81) was found for unilateral and bilateral strength imbalance ratios. High intraclass correlation coefficient values (0.87-0.97) were found for peak torque. Concerning absolute reliability, the standard error of measurement ranged from 9.1 to 25.6% for strength imbalance ratios and from 7.7 to 14.5% for peak torque measurements, and minimal detectable change ranged from 25.2 to 71% for strength imbalance ratios and from 21.3 to 40.2% for peak torque measurements. CONCLUSIONS: The standard error of measurement and minimal detectable change reported in the present study should be taken into account when evaluating the individual longitudinal changes in clinical practice

Reliability of the time to peak torque and the joint angle at peak torque of the isokinetic dynamometer

International audienceBackground: Although peak torque has shown acceptable reproducibility, this may not be the case with two other often used parameters: time to peak torque (TPT) and the angle of peak torque (APT). Those two parameters should be used for the characterization of muscular adaptations in athletesMethods: The isokinetic performance of the knee extensors and flexors in both limbs was measured in 29 male athletes. The experimental protocol consisted of 3 consecutive identical paradigms separated by 45 min breaks. Each test consisted of 4 maximal concentric efforts performed at 60 and 180°/s. Reproducibility was quantified by the standart error measurement (SEM), the coefficient of variation (CV) and by means of intra-class correlation coefficients (ICCs) with the calculation of 6 forms of ICCs.Results: Using ICC as the indicator of reproducibility, the correlations for TPT of both limbs showed a range of 0.51-0.65 in extension and 0.50-0.63 in flexion. For APT, the values were 0.46-0.60 and 0.51-0.81, respectively. In addition, the calculated standard error of measurement (SEM) and CV scores confirmed the low level of absolute reproducibility. Conclusions: Due to their low reproducibility, neither TPT nor APT can serve as independent isokinetic parameters of knee flexor and extensor performance. So, given its reproducibility level, TPT and APT should not be used for the characterization of muscular adaptations in athletes

Screening for surgical nosocomial infections by crossing databases

SummarySurgical site infection (SSI) is a major cause of morbidity and mortality, and they are the third cause of nosocomial infections. It has been shown that surveillance can reduce the rate of these infections because the publication of the results that introduce a interrogation on her surgical pratices. However, surveillance requires considerable medical resources. Our objective is to validate a computer algorithm that uses microbiological results and the results of a C-reactive protein (CRP) assay and granulocyte count to detect SSIs.Materials and methodsAll patients who underwent colorectal surgery between the 1st of January and the 30th of June 2009 were included. Administrative, surgical and microbiological data and the appearance of neutrophilia and CRP after surgery and during hospitalization were collected. The algorithm uses four biological variables: CRP, neutrophils, and the bacterium found on the positive sample. The CRP and neutrophil variables were coded in 0 or 1. CRP was coded as 1 if the sample was below 5mg/l at the time of the operation and increased to more than 60mg/l in the 30 days immediately after post-operation. Neutrophils were coded as 1 if the sample was normal at the time of the operation and increased to more than 12,000cells/mm3 in the 30 days immediately after post-operation. The “type of sample” and “bacterium” variables were coded in categories. For the type of sample, we coded 3 if the sampling site was related to the surgical site, 2 if the sampling site was potentially linked to the surgical site, 1 if the sampling site was not directly or indirectly related to the surgical site and 0 if there was no sample. Regarding the bacteria, we coded 3 for bacteria found in over 5% of SSIs, 2 for bacteria found in 2–5% of SSIs, 1 for bacteria found in less than 2% of SSIs and 0 if there were no bacteria. The algorithm calculates a score from 1 to 5.ResultsOur study included 195 operations, out of which it was possible to study 168. Following the operations, we found neutrophilia above 12,000cells/mm3 in 41.5% of cases and CRP above 60mg/l in 64.6% of cases. Thirty-seven operations (22%) were complicated by an SSI. The positive predictive values and the negative predictive values in our algorithm were 74.07% and 87.94%, respectively, and the number of records that remain to be investigated is 27 out of 168.ConclusionsLinking databases from bacteriology and biology with those containing the hospital records of surgical procedures is a simple method for identifying surgical nosocomial infections