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Redalyc.Onset of Quadriceps Activation and Torque Variation ConScientiae Saúde ISSN: 1677-1028 [email protected] Universidade Nove de Julho Brasil Uliam Kuriki, Heloyse; Mícolis de Azevedo, Fábio; Negrão Filho, Rúben de Faria; Alves, Neri Onset of quadriceps activation and torque variation during stair ascent in individuals with patellofemoral pain ConScientiae Saúde, vol. 11, núm. 4, 2012, pp. 642-650 Universidade Nove de Julho São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=92924959015 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative DOI: 10.5585/ConsSaude.v11n4.3810 Recebido em 18 jul. 2012. Aprovado em 26 out. 2012 Onset of quadriceps activation and torque variation during stair ascent in individuals with patellofemoral pain Início de ativação do quadríceps e variação do torque durante a subida de escada em indivíduos com dor patelofemoral Heloyse Uliam Kuriki1; Fábio Mícolis de Azevedo2; Rúben de Faria Negrão Filho2; Neri Alves3 1 Fisioterapeuta, Mestre, Doutoranda do Programa de Pós-Graduação Interunidades Bioengenharia, Escola de Engenharia de São Carlos, USP, São Carlos, SP; Membro do Laboratório de Biomecânica e Controle Motor, Faculdade de Ciências e Tecnologia – Unesp. Presidente Prudente, SP – Brasil. 2 Fisioterapeutas, Doutores, Membros do Laboratório de Biomecânica e Controle Motor, Faculdade de Ciências e Tecnologia – Unesp. Presidente Prudente, SP – Brasil. 3 Físico, Doutor, Docente do Programa de Pós-Graduação Interunidades Bioengenharia, Escola de Engenharia de São Carlos, USP, São Carlos, SP – Brasil; Membro do Laboratório de Biomecânica e Controle Motor, Faculdade de Ciências e Tecnologia – Unesp. Presidente Prudente, SP – Brasil. Postal address Heloyse Uliam Kuriki R. Roberto Simonsen, 305 19060-080 – Presidente Prudente – SP [Brasil] [email protected] Abstract Introduction: Studies have used surface electromyography (EMG) to understand motor recruitment in individuals with patellofemoral pain syndrome (PFPS); however, there is no consensus in the literature. Objective: To understand if, in addition to neuromuscular disorders, there are changes in rotational patterns in individuals with PFPS. Methods: Twenty-two control pain-free subjects and eleven subjects with PFPS were assessed during stair ascent with respect to the onset of muscle activation and percentage of torque variation (PTV). Result: The PFPS group showed previous activation of vastus lateralis (VL) (21.1 ± 58.1ms), while simultaneous activation was observed in the control group (2.8 ± 30.7ms, p=0.01). The groups also showed differences in relation to the PTV (p=0.02): the control group showed greater variation in torque (26.7 ± 35.3%) compared to the PFPS group (17.5 ± 35.9%). Conclusion: People with PFPS have prior activation of VL and lower tendency towards body rotation, which may suggest patellar lateralization. Key words: Electromyography; Patellofemoral pain syndrome; Torque. Resumo Introdução: Estudos têm utilizado a eletromiografia de superfície (EMG) para entender o recrutamento motor em indivíduos com síndrome dolorosa patelo- femoral (SDFP); porém, não há um consenso na literatura. Objetivo: Entender se, além de desordens neuromusculares, há mudanças nos padrões de rotação nos indivíduos com SDFP. Métodos: Vinte e dois indivíduos controles sem dor e onze com SDFP foram avaliados com relação ao início de ativação muscular e à porcentagem de variação do torque (PVT). Resultados: O grupo SDFP apresentou ativação prévia do vasto lateral (VL) (21,1 ± 58,1ms), e o grupo controle, ativação simultânea (2,8 ± 30,7ms, p=0,01). Os grupos também mostraram diferenças em relação à PVT (p=0,02): o grupo controle mostrou uma maior variação do torque (26,7 ± 35,3%) em comparação ao SDFP (17,5 ± 35,9%). Conclusão: Pessoas com SDFP possuem ativação prévia do VL e menor tendência de rotação do corpo, o que pode sugerir lateralização patelar. Descritores: Eletromiografia; Síndrome da dor patelofemoral; Torque. 642 ConScientiae Saúde, 2012;11(4):642-650. Kuriki HU, Azevedo FM, Negrão Filho RF, Alves N Introduction the point of attaining 5% of maximal isomet- ric contraction. Some studies have concluded Patellofemoral pain syndrome (PFPS) is that there is early activation of the VL in sub- described as a diffuse, anterior, or retro-patellar jects with pain, a factor responsible for both Editorial pain which, in the absence of other diseases, the lateralization of the patella and the pain. is exacerbated by physical or functional activi- However, other studies have shown that sur- ties that overload the patellofemoral joint, such face electromyography (EMG) does not iden- as sitting for a long time and ascending stairs1. tify individuals with this syndrome4. Both extrinsic and intrinsic factors have been To understand PFPS etiology, other stud- suggested as causes of PFPS. Extrinsic factors ies being developed have attempted to exam- are related to excessive physical activity or in- ine anatomical differences and rotational pa- Ciências básicas activity. Intrinsic factors, including the imbal- rameters by assessing the patellofemoral joint ance between the vastus lateralis (VL) and vas- using functional magnetic resonance imaging 6-10 tus medialis (VM) of the quadriceps, increased or kinetics and kinematics . The torque pro- Q angle, patellar hyper-mobility, patellar mis- duced by the whole body around the vertical alignment, and excessive rotation of the tibia or axis is generated from the sum of the horizon- femur2, 3, have been commonly studied and used tal components of the ground reaction force11, aplicadas to characterize PFPS. Due to the large number and thus, it can be assumed that the variation Ciências of people affected by PFPS and its multifactorial of the torque around the vertical axis, pro- etiology, PFPS is still the focus of many stud- duced by the foot on the force plate, reflects ies aiming to discover its cause. Discovering a global trend of the rotational movement. the cause of PFPS would facilitate a clinical ap- The hypothesis is that if there is an anoma- proach, reduce pain, improve quality of life, and lous rotation in the lower limbs (exacerbated enable prevention. rotation or a rotation deficit), this rotation can de literatura Despite the growing number of stud- cause gait changes and, therefore, changes in Revisões ies focusing on PFPS, results have not been the torque at the support point. Pain can pro- conclusive, possibly due to differences in ex- duce changes in the dynamics of certain ac- perimental protocol, the analyzed activity, tions used to avoid or minimize it. It would be and signal processing4. Voight and Wieder5 interesting to evaluate the parameters related showed that there is early activation of the to EMG, as they would provide information VL in relation to the VM in individuals with about this activation pattern, in addition to its pain as a reflex response to the percussion of dynamic aspects. Knowledge of its etiology is Avaliadores the patellar tendon. Since then, many stud- needed to avoid inadequate treatment. ies have focused on the early activation of a EMG and the force plate provide infor- portion of the quadriceps muscles during dif- mation about motor, anatomical, and physio- ferent activities requiring knee extension. As logical characteristics after signal processing. discussed in a review article4, several studies These tools were selected to evaluate individ- have examined the imbalance of muscle action uals with and without PFPS during stair as- para os autores in the patellar reflex during walking, climb- cent because individuals with PFPS commonly Instruções ing or descending steps, and squatting. Some report stair climbing as a functional activity authors have determined the onset using au- that generates significant pain. The aim of this tomatic detection, with activation defined as study is to verify the contribution of muscular the point when the signal increases more than and mechanical parameters to PFPS: the acti- one, three, or five standard deviations above vation time of the VM in relation to the VL, the baseline mean or when the peak signal and the torque produced around the vertical is reached. Others have defined the onset as axis of the force plate. ConScientiae Saúde, 2012;11(4):642-650. 643 Onset of quadriceps activation and torque variation during stair ascent in individuals with patellofemoral pain Material and methods between them, and the motor point localization was obtained by electro-stimulation). The refer- Sample ence electrode was positioned at the ulnar sty- Thirty-three female individuals were eval- loid process. On the electrode cable, there was uated and separated into two groups: i) control a pre-amplifier circuit with a gain of 20, CMRR group: 22 pain-free, right-handed individuals, (Common Mode Rejection Ratio) greater than 80 with a mean age of 23 ± 2 years, mean weight dB, and impedance of 1012 Ω. The data were col- of 55.0 ± 6.0 kg, and mean height of 161.2 ± 4.8 lected using AqdAnalysis software (Lynx®, Sao cm; ii) PFPS group: 11 right-handed individuals, Paulo, SP, BRA; model EMG 1000-8-4I). with a mean age of 24 ± 3 years, mean weight For the torque evaluation, an AMTI force of 57.3 ± 5.3 kg, and mean height of 161.9 ± 5.9 plate (Advanced Medical Technologies Inc., cm, all diagnosed with PFPS and pain in the Watertown, MA, USA;
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