Teaching: Faculdade de Ciências Médicas da Santa Casa de São PauloFaculdade de Ciências Médicas da Santa Casa de São Paulo · Physical Therapy Department · Hip, knee, and Sports GroupBrazil · São Paulo
Research: Universidade Federal de São PauloUniversidade Federal de São Paulo · Experimental surgery Department · LaserBrazil · São Paulo
Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP)Musculoskeletal disorders · PhDBrazil · São Paulo
Article: Open Kinetic Chain Exercises in a Restricted Range of Motion After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Clinical Trial.Thiago Yukio Fukuda, Deborah Fingerhut, Viviane Coimbra Moreira, Paula Maria Ferreira Camarini, Nathalia Folco Scodeller, Aires Duarte, Mauro Martinelli, Flavio Fernandes Bryk[show abstract] [hide abstract]
ABSTRACT: BACKGROUND:Recent studies have shown that an early start of open kinetic chain (OKC) exercises for quadriceps strengthening in a full range of motion (ROM) could increase anterior knee laxity after anterior cruciate ligament (ACL) reconstruction with flexor tendons. However, there are no clinical trials that evaluated outcomes of OKC exercises in a restricted ROM for pain, function, muscle strength, and anterior knee laxity at 1 year after surgery. PURPOSE:To determine if an early start of OKC exercises for quadriceps strength in a restricted ROM would promote a clinical improvement without causing increased anterior knee laxity in patients after ACL reconstruction. STUDY DESIGN:Randomized controlled clinical trial; Level of evidence, 1. METHODS:A total of 49 patients between 16 and 50 years of age who underwent ACL reconstruction with semitendinosus and gracilis autografts were randomly assigned to an early start OKC (EOKC) exercise group or a late start OKC (LOKC) exercise group. The EOKC group (n = 25; mean age, 26 years) received a rehabilitation protocol with an early start of OKC (fourth week postoperatively) within a restricted ROM between 45° and 90°. The LOKC group (n = 24; mean age, 24 years) performed the same protocol with a late start of OKC exercises between 0° and 90° (12th week postoperatively). Quadriceps and hamstring muscle strength, 11-point numerical pain rating scale (NPRS), Lysholm knee scoring scale, single-legged and crossover hop tests, and anterior knee laxity were measured to assess outcomes at the 12-week, 19-week, 25-week, and 17-month postoperative follow-up (range, 13-24 months). RESULTS:No difference (P < .05) was noted between groups with respect to demographic data. Both groups (EOKC and LOKC) had a higher level of function and less pain at the 19-week, 25-week, and 17-month assessments when compared with 12 weeks postoperatively (P < .05). The EOKC group had improved quadriceps muscle strength at the 19-week, 25-week, and 17-month follow-up when compared with 12 weeks postoperatively (P < .05); the LOKC group showed improvement only at the 17-month postoperative assessment. However, the analysis between groups showed no difference for all pain and functional assessments, including anterior knee laxity (P > .05). CONCLUSION:An early start of OKC exercises for quadriceps strengthening in a restricted ROM did not differ from a late start in terms of anterior knee laxity. The EOKC group reached the same findings in relation to pain decrease and functional improvement when compared with the LOKC group but showed a faster recovery in quadriceps strength. The nonweightbearing exercises seem appropriate for patients who have undergone ACL reconstruction, when utilized in a specific ROM. The magnitude of difference in quadriceps strength between the 2 rehabilitation protocols was around 5%; however, this difference was not clinically significant, especially because both groups had equal function on the hop tests.The American journal of sports medicine 02/2013; · 3.61 Impact Factor
Article: Use of the Gait Deviation Index and spatiotemporal variables for the assessment of dual task interference paradigm.Danielli Souza Speciali, Elaine Menezes de Oliveira, Nadia Maria Dos Santos, Fernando Vieira Pereira, América Cristina Fracini, Thiago Yukio Fukuda, Claudia Santos Oliveira, João Carlos Correa, Paulo Roberto Garcia Lucareli[show abstract] [hide abstract]
ABSTRACT: Three-dimensional gait analysis (3DGA) is an important element in the quantitative evaluation of gait in subjects with Parkinson's disease (PD). Indexes, such as the Gait Deviation Index (GDI), have recently been proposed as a summary measure of gait. The aim of the present study was to investigate the effectiveness of the GDI and spatiotemporal variables in the quantification of changes in gait during a dual-task (DT) exercise. Fourteen patients with idiopathic PD and nine healthy subjects (CG) participated in the study. All subjects walked under two conditions: free walking and DT walking. The GDI was computed from the 3DGA data. The results show gait impairment during DT, a significant difference between groups regarding GDI and an interaction effect involving the group, side and task factors. The CG and PDG were different independent of interference and side, but interference was only different for the PDG group. The results also demonstrate that the GDI should be an appropriate outcome measure for the evaluation of the effects of DT on patients with Parkinson's disease.Journal of bodywork and movement therapies 01/2013; 17(1):19-27.
Article: ISOMETRIC STRENGTH RATIOS OF THE HIP MUSCULATURE IN FEMALES WITH PATELLOFEMORAL PAIN: A COMPARISON TO PAINFREE CONTROLS.[show abstract] [hide abstract]
ABSTRACT: The purpose of the study was to compare hip agonist-antagonist isometric strength ratios between females with patellofemoral pain syndrome (PFP) and pain-free control group. One hundred and twenty females between 15 and 40 years of age (control group: n=60; PFP group: n=60) participated. Hip adductor, abductor, medial rotator, lateral rotator, flexor, and extensor isometric strength was measured using a hand-held dynamometer. Comparisons in the hip adductor/abductor and medial/lateral rotator and flexor/extensor strength ratios were made between groups using independent t-tests. Group comparisons also were made between the anteromedial hip complex (adductor, medial rotator, and flexor musculature) and posterolateral hip complex (abductor, lateral rotator, and extensor musculature). On average, the hip adductor/abductor isometric strength ratio in the PFP group was 23% higher when compared to the control group (P=0.01). The anteromedial/posterolateral complex ratio also was significantly higher in the PFP group (average 8%; P=0.04). No significant group differences were found for the medial/lateral rotator ratio and flexor/extensor strength ratios. The results of this study demonstrate that females with PFP have altered hip strength ratios when compared to asymptomatic controls. These strength imbalances may explain the tendency of females with PFP to demonstrate kinematic tendencies that increase loading on the patellofemoral joint (ie. dynamic knee valgus).The Journal of Strength and Conditioning Research 11/2012; · 1.83 Impact Factor
Article: Infrared low-level diode laser on inflammatory process modulation in mice: pro- and anti-inflammatory cytokines.[show abstract] [hide abstract]
ABSTRACT: To evaluate the modulation of proinflammatory (interleukin-6, IL-6; tumor necrosis factor-α, TNF-α; and interferon-γ, IFN-γ) and anti-inflammatory cytokines (transforming growth factor-β1, TGF-β1) in the inflammation processes in vivo with low-level laser action, 50 isogenic mice were randomly distributed into three groups: control (no surgical procedure, n = 10), sham (surgical procedure with three standard cutaneous incisions, followed by an abdominal muscle incision and suture, n = 20), and laser (same procedure followed by laser exposure, n = 20). The sham group was divided into three subgroups: sham I (euthanasia and evaluation, 36 h after surgical procedure), sham II (euthanasia and evaluation, 60 h after surgical procedure), and sham III (euthanasia and evaluation, 84 h after surgical procedure). The laser group was also divided in three subgroups: laser I (a single laser session, 12 h after surgery), laser II (two laser sessions, 12 and 36 h after surgery), and laser III (three laser sessions, 12, 36, and 60 h after surgery). All animals in the laser groups received three points per session of continuous infrared laser (wavelength of 780 nm, power of 20 mW, fluency of 10 J/cm(2), exposure time of 20 s per point, and energy of 0.4 J). After euthanasia, spleen mononuclear cells were isolated and cultured for 48 h. Concentrations of IL-6, TNF-α, IFN-γ, and TGF-β1 were obtained by enzyme-linked immunosorbent assay method. There was a significant difference between the IL-6 and TNF-α concentrations in the 60-and 84-h evaluations when the laser and sham groups were compared to the control group (p < 0.05), except for laser II in the TNF-α analysis (p > 0.05). The IFN-γ concentration analysis showed a significant difference only in sham II when compared to the control group (p < 0.05). Thus, there was a modulatory effect of TNF-α and IFN-γ in the laser group, particularly in the 60-h postoperative evaluation. There was no significant difference between the laser, sham, and control groups for TGF-β1 analysis (p > 0.05). The low-level laser application decreased the TNF-α and IFN-γ release in vivo of spleen mononuclear cells in mice, especially after two exposure sessions. However, there was no modulation of the IL-6 and TGF-β1 release.Lasers in Medical Science 11/2012; · 2.00 Impact Factor
Article: Hip Posterolateral Musculature Strengthening in Sedentary Women With Patellofemoral Pain Syndrome: A Randomized Controlled Clinical Trial With 1-Year Follow-up.Thiago Yukio Fukuda, William Pagotti Melo, Bruno Marcos Zaffalon, Flavio Marcondes Rossetto, Eduardo Magalhães, Flavio Fernandes Bryk, Robroy L Martin[show abstract] [hide abstract]
ABSTRACT: Randomized controlled trial. To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome (PFPS). Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS. However, there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises. Fifty-four sedentary women between 20 and 40 years of age, with a diagnosis of unilateral PFPS, were randomly assigned knee exercise (KE) or knee and hip exercise (KHE). The women in the KE group (n = 26; mean age, 23 years) performed a 4-week conventional knee-stretching and -strengthening program. The women in the KHE group (n = 28; mean age, 22 years) performed the same exercises as those in the KE group, as well as strengthening exercises for the hip abductors, lateral rotators, and extensors. An 11-point numeric pain rating scale, the Lower Extremity Functional Scale, the Anterior Knee Pain Scale, and a single-hop test were used as outcome measures at baseline (pretreatment) and 3, 6, and 12 months posttreatment. At baseline, demographic, pain, and functional assessment data were similar between groups. Those in the KHE group had a higher level of function and less pain at 3, 6, and 12 months compared to baseline (P<.05). In contrast, the KE group had reduced pain only at the 3- and 6-month follow-ups (P<.05), without any changes in Lower Extremity Functional Scale, Anterior Knee Pain Scale, or hop testing (P>.05) through the course of the study. Compared to the KE group, the KHE group had less pain and better function at 3, 6, and 12 months posttreatment (P<.05). For the Lower Extremity Functional Scale, the between-group difference in change scores from baseline at 3, 6, and 12 months posttreatment favored the KHE group by 22.0, 22.0, and 20.8 points, respectively. Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS. Therapy, level 1a.J Orthop Sports Phys Ther 2012;42(10):823-830, Epub 2 August 2012. doi:10.2519/jospt.2012.4184.The Journal of orthopaedic and sports physical therapy. 08/2012; 42(10):823-30.