domingo, 29 de novembro de 2009

ARTIGO DO MÊS - 28/2009

Anterior Cruciate Ligament Deficiency Causes Brain Plasticity
Kapreli, E;  Athanasopoulos, S.; Gliatis, J.; Papathanasiou, M. ; Peeters, R.;  Strimpakos, N.;  Hecke, P.V.;  Gouliamos, A.; Sunaert, S.
Am J Sports Med 2009 37: 2419

Background: The mechanoreceptors located in anterior cruciate ligament (ACL) constitute an afferent source of information toward the central nervous system. It has been proposed that ACL deficiency causes a disturbance in neuromuscular control, affects central programs and consequently the motor response resulting in serious dysfunction of the injured limb.

Purpose: The objective of this study was to investigate whether chronic anterior cruciate ligament injury causes plastic changes in brain activation patterns.

Study Design: Case control study; Level of evidence, 3.

Methods: Seventeen right leg–dominant male participants with chronic anterior cruciate ligament deficiency and 18 matched healthy male participants with no special sport or habitual physical activity participated in this study. Patient selection criteria comprised a complete right unilateral anterior cruciate ligament rupture ≥6 months before testing. Brain activation was examined by using functional magnetic resonance imaging technique (1.5-T scanner).

Results: Results show that patients with anterior cruciate ligament deficiency had diminished activation in several sensorimotor cortical areas and increased activation in 3 areas compared with controls: presupplementary motor area, posterior secondary somatosensory area, and posterior inferior temporal gyrus.

Conclusion: The current study reveals that anterior cruciate ligament deficiency can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This evidence could explain clinical symptoms that accompany this type of injury and lead to severe dysfunction.Understanding the pattern of brain activation after a peripheral joint injury such as anterior cruciate ligament injury lead to new standards in rehabilitation and motor control learning with a wide application in a number of clinical and research areas (eg,surgical procedures, patient re-education, athletic training, etc).

Keywords: anterior cruciate ligament (ACL) deficiency; noncopers; central nervous system; reorganization; plasticity; functional magnetic resonance imaging (fMRI)

(...) rehabilitation should focus on CNS reeducation rather than optimizing only the peripheral neuromuscular function. Therapists should take advantage of the adaptive abilities of the CNS, identifying the goals, providing the tools, and allowing the CNS to find a solution.
(...) rehabilitation  should be based on procedures that stimulate the learning process and CNS reprogramming

domingo, 15 de novembro de 2009


A Systematic Review of Anterior Cruciate Ligament Reconstruction with Autograft Compared with Allograft
Carey,J.; Dunn, W.R.; MPH, Dahm, D.L.; Zeger, S.L.; and Spindler, K.P.
J. Bone Joint Surg Am. 2009;91:2242-50

Background: Anterior cruciate ligament reconstruction can be performed with use of either autograft or allograft tissue. It is currently unclear if the outcomes of these two methods differ significantly. This systematic review and meta-analysis investigated whether the short-term clinical outcomes of anterior cruciate reconstruction with allograft were significantly different from those with autograft.

Methods: A computerized search of the electronic databases MEDLINE and EMBASE was conducted. Only therapeutic studies with a prospective or retrospective comparative design were considered for inclusion in the present investigation. Two reviewers independently assessed the methodological quality and extracted relevant data from each included study. If a study failed the qualitative assessment and statistical tests of homogeneity, it was excluded from the meta-analysis. Furthermore, a study was withdrawn fromthe meta-analysis of a particular outcome if that outcome was not studied or was not reported adequately. A Mantel-Haenszel analysis utilizing a random-effects model allowed for pooling of results according to graft source while accounting for the number of subjects in individual studies.

Results: Nine studies were determined to be appropriate for the systematic review. Eight studies compared bone-patellar tendon-bone grafts, and one study compared quadruple-stranded hamstring grafts. Five studies were prospective comparative studies, and four were retrospective comparative studies. One study, which investigated allografts that underwent a unique sterilization process, demonstrated an allograft failure rate of 45% (thirty-eight of eighty-five). That study failed the qualitative assessment and statistical tests of homogeneity and consequently was excluded from the meta-analysis. When the outcomes from the remaining studies were pooled according to graft source, the meta-analyses of the Lysholm score, instrumented laxity measurements, and the clinical failure rate estimated mean differences and odds ratios that were not significant. These findings were robust during the sensitivity analysis, which varied the included studies or variables on the basis of graft type, instrumented laxity cut-off value, secondary sterilization technique, duration of follow-up, mean patient age, and study methodology.

Conclusions: In general, the short-term clinical outcomes of anterior cruciate reconstruction with allograft were not significantly different from those with autograft. However, it is important to note that none of these nonrandomized studies stratified outcomes according to age or utilized multivariable modeling to mathematically control for age (or any other possible confounder, such as activity level, that is not equally distributed in the two treatment groups). Understanding these limitations of the best available evidence, the surgeon may incorporate the results of the present systematic review into the informed-consent and shared-decision-making process in order to individualize optimum patient care.

Level of Evidence: Therapeutic Level III.

sábado, 7 de novembro de 2009


Na 19ª conferência anual da INTERNATIONAL ASSOCIATION FOR DANCE MEDICINE & SCIENCE (IADMS) realizado em Haia - Holanda entre os dias 29 e 31 de Outubro de 2009, apresentámos um tema , em conjunto com o Prof. Luis Xarez da Faculdade de Motricidade Humana, sobre "COOL-DOWN PROGRAM FOR DANCERS"

Aqui fica uma breve sintese das ideias-chaves apresentadas

WHY dancers should do cool-down program?

The cool down program is just as important as the warm up to ensure muscle protection from extreme soreness, to help effort recovery, to prevent unforeseen injuries and allows the heart rate to return to normal. The main aim of the cool down program is to promote active recovery and return the body to a pre exercise, or pre work out level.

During a strenuous dancing activity body´s dancers go through a number of stressful processes. Neuromuscular system, tendons and joint structures get damaged, and waste products build up within your body. The cool down program, performed properly, will assist your body in its repair and recovery process. One area the cool down will help with is "post exercise muscle soreness."


WHAT it is?

Cool down exercises usually consist of slower dancing, relaxation exercises and active stretches exercises that are designed to lower your heartbeat after dancing and contribute for active recovery after a hard work activity. Making the cool down a permanent part of your regular dance routine is recommended helping a better physically recovery.


WHEN should dancers do this program?

Dancers must develop and perform an appropriate cool down exercises routine after dancing rigorously (class, rehearsal or performance) and before total stop dancing activity.


HOW to organize it?

It depends of individual characteristics (age, fitness, technical level) and the context (time of the day, season time, room conditions). There are some items dancers have to follow: duration, intensity and specificity of exercises


Key-Points of our warm-down program

1) Pick a slower song and dance to it-just be sure you are still moving your body, but going from a fast paced rhythm to a slower paced rhythm. If you just stop cold turkey after dancing, you will put your body at risk. SOME MOVEMENTS BUT SLOWER RHYTM.

2) ACTIVE STRETCHING EXERCICES of the principal muscles that had been working – this program needs to have a common base (depends on type of Dance) and personnel basis (depends of the past or recent history of injuries or complaints). Goal: Release any tension from the joints and muscles. Specificity and duration of exercises depend of type of dance and individual characteristics.

3) Be sure to take the time to slow down your heartbeat the proper way. Have time and prepare your mind to feel your body and the anatomic regions you feel tired or soreness (special trunk, shoulders, and pelvic girdle – axial joints and postural and respiratory muscles) ACTIVE MIND/BODY RELAXATION EXERCICES.

4) Finally you should then spend two to three minutes lying completely flat and feel your body and your breathing.

WHO should prepare it?

You must do it. Nobody can do it for you. Take an advice and learn with your teacher, other dancers and physical therapists with experience in dance activities BUT DO YOURSELF.

Luis Xarez e Raul Oliveira


The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals With Functional Ankle Instability

Erin Caffrey, Carrie L. Docherty, John Schrader, Joanne Klossner
DOI: 10.2519/jospt.2009.3042 in JOSPT NOVEMBER 2009, Volume 39, No. 11

STUDY DESIGN: Experimental laboratory testing using a cross-sectional design.

 OBJECTIVES: To determine if functional performance deficits are present in individuals with functional ankle instability (FAI) in 4 single-limb hopping tests, including figure-of-8 hop, side hop, 6-meter crossover hop, and square hop.

BACKGROUND: Conflicting results exist regarding the presence of functional deficits in individuals with FAI. It is important to evaluate whether functional performance deficits are present in this population, as well as if subjective feelings of giving way can assist in identifying these deficits.

METHODS: Sixty college students volunteered for this study. Thirty participants with unilateral ankle instability were placed in the FAI group and 30 participants with no history of ankle injuries were placed in the control group. The FAI group was subsequently further divided to indicate those that reported giving way during the functional test (FAI-GW) and those that did not (FAI-NGW). Time to complete each test was recorded and the mean of 3 trials for each test were used for statistical analysis. To identify performance differences, we used 4 mixed-design 2-way (side-by-group) ANOVAs, 1 for each hop test. A Tukey post hoc test was completed on all significant findings.

RESULTS: We identified a significant side-by-group interaction for all 4 functional performance tests (P<.05). Specifically, for each functional performance test, the FAI limb performed significantly worse than the contralateral uninjured limb in the FAI-GW group. Additionally, the FAI limb in the FAI-GW group performed worse than the FAI limb in the FAI-NGW group, and the matched limb in the control group in 3 of the 4 functional performance tests.

CONCLUSION: We found that functional performance deficits were present in participants with FAI who also experienced instability during the test. This difference was identified when comparing the FAI limb to the contralateral uninjured limb as well as control participants. However, the performance deficits identified in this study were relatively small. Future research in this area is needed to further evaluate the clinical meaningfulness of these findings. Finally, we found that limb dominance did not affect performance.

KEY WORDS: 6-meter crossover hop, agility, figure-of-8 hop, side hop, square hop

The authors determine if functional performance deficits are present in individuals with functional ankle instability (FAI) in 4 single-limb hopping tests, including figure-of-8 hop, side hop, 6-meter crossover hop, and square hop.

Comentário: Os testes de desempenho funcional representativos de cada segmento funcional e da sua coordenação/interacção com os segmentos adjacentes envolvendo os mecanismos neuromotores que os controlam podem ser variáveis a integrar quer na avaliação quer na reeducação/normalização da função.

terça-feira, 3 de novembro de 2009


Aqui está o link com a reportagem que passou no telejornal de Domingo (ontem), na RTP 1, sobre o programa R´EQUILIBRIO – Programa de Exercício e Saúde, onde se PROMOVEM ESTILOS DE VIDA ACTIVOS/SAUDÁVEIS


O Volume 39, No. 11/2009 da revista Journal of Orthopaedic and Sports Physical Therapy da secção do mesmo nome da American Physical Therapy Association (APTA) está disponível online para os membros do Grupo de Interesse de Fisioterapia n Desporto da nossa Associação que tenham aderido Aqui fica o indíce :

Mechanosensitivity of the Lower Extremity Nervous System During Straight-Leg Raise Neurodynamic Testing in Healthy Individuals  Benjamin S. Boyd, Linda Wanek, Andrew T. Gray, Kimberly S. Topp

Changes in Lateral Abdominal Muscle Thickness During the Abdominal Drawing-in Maneuver in Those With Lumbopelvic Pain

Deydre S. Teyhen, Laura N. Bluemle, Jeffery A. Dolbeer, Sarah E. Baker, Joseph M. Molloy, Jackie L. Whittaker, Maj John D. Childs

Patellar Tendon Rupture in a Basketball Player    - Sean D. Johnson, Kornelia Kulig

The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals With Functional Ankle Instability  Erin Caffrey, Carrie L. Docherty, John Schrader, Joanne Klossner

Knee Extension and Flexion Weakness in People With Knee Osteoarthritis: Is Antagonist Cocontraction a Factor?     Tamika L. Heiden, David G. Lloyd, Timothy R. Ackland

Choosing Among 3 Ankle-Foot Orthoses for a Patient With Stage II Posterior Tibial Tendon Dysfunction      Christopher Neville, Jeff R. Houck

Acute Dislocation of the Proximal Tibiofibular Joint    Chih-Hsin Hsieh, Jian-Chih Chen

Scapular Summit 2009  William B Kibler, Paula M. Ludewig, Philip W. McClure, Timothy L. Uhl, Aaron Sciascia


Aqui está um link com uma videoreportagem que passou no Telejornal da RTP no Domingo dia 1 de Novembro sobre o n/ programa Requilibrio - Mexer-se pela Saúde.

O que se pretende é PROMOVER ESTILOS DE VIDA ACTIVOS/SAUDÁVEIS estimulando actividades físicas regulares num contexto de educação para a saúde onde se abordam diversos temas relacionados com a alimentação/nutrição, controle do peso, prevenção de lesões e disfunções, educação postural e autonomia funcional.

para mais informações consulte o link aqui ao lado :

Raul Oliveira

segunda-feira, 2 de novembro de 2009