Context: People with patellofemoral pain (PFP) present altered lower-limb movements during some activities. Perhaps, joint misalignment in the hip is one of the reasons for altered movement patterns in people with PFP. Some mobilization techniques have been designed to address joint misalignments. Objective: To investigate the acute effects of hip mobilization with movement (MWM) technique on pain and biomechanics during squats and jumps in females with and without PFP. Design: Randomized, placebo-controlled trial. Setting: Movement analysis laboratory. Patients: Fifty-six physically active females (28 with PFP and 28 asymptomatic) were divided into 4 groups: experimental group with PFP, sham group with PFP, experimental group without PFP, and sham group without PFP. Intervention(s): The experimental groups received MWM for the hip, and the sham groups received sham mobilization. Main Outcome Measures: Pain, trunk, and lower-limb kinematics, and hip and knee kinetics during single-leg squats and landings. Results: After the interventions, no difference between groups was found for pain. The PFP experimental group decreased hip internal rotation during squats compared with the PFP sham group (P = .03). There was no other significant difference between PFP groups for kinematic or kinetic outcomes during squats, as well as for any outcome during landings. There was no difference between asymptomatic groups for any of the outcomes in any of the tasks. Conclusions: Hip mobilization was ineffective to reduce pain in people with PFP. Hip MWM may contribute to dynamic lower-limb realignment in females with PFP by decreasing hip internal rotation during squats. Therefore, hip MWM could be potentially useful as a complementary intervention for patients with PFP.
Guilherme S. Nunes, Débora Faria Wolf, Daniel Augusto dos Santos, Marcos de Noronha and Fábio Viadanna Serrão
Guilherme S. Nunes, Gabriela S. Bayer, Leticia M.R. da Costa and Marcos de Noronha
Context: Physical therapists often have to measure ankle range of motion (ROM) to decide on intervention and investigate improvements. The most common method of measurement is goniometry, but it has been questioned due to its unsatisfactory levels of reliability. Objective: To investigate the intraobserver and interobserver reliability of a new method of measuring plantar-flexion ROM. Design: Prospective and descriptive. Setting: Laboratory. Participants: 20 healthy participants (12 women and 8 men). Main Outcome Measurements: Ankle plantar flexion was measured by 3 observers (A, B, and C) with 3 methods (goniometry, measurement in hook-lying position [MHP], and static-image analysis [SIA]). Observer A was the most experienced therapist, and C, the least. MHP was performed with the participant in the supine position, knees flexed, and first and fifth metatarsals in contact with the treatment table. SIA was recorded and analyzed in the same position. Goniometry was performed with participant seated, lower legs unsupported, and axis positioned on the lateral malleolus. Results: For the interobserver analysis, the ICC2,1 was high for the MHP (.88), high for SIA (.87), and moderate for goniometry (.57). For the intraobserver analysis, the ICC2,1 was high or very high for MHP (.91-.92), high for SIA (.79-.83), and low to moderate for goniometry (.18-.60). Conclusion: MHP is inexpensive, fast, and more reliable than goniometry for measuring plantar-flexion ROM.
Marcos de Noronha, Eleisha K. Lay, Madelyn R. Mcphee, George Mnatzaganian and Guilherme S. Nunes
Context: Ankle sprains are common injuries in sports, but it is unclear whether they are more likely to occur in a specific period of a sporting game. Objective: To systematically review the literature investigating when in a match ankle sprains most likely occurred. Evidence Acquisition: The databases CINAHL, EMBASE, MEDLINE, and SPORTDiscus were searched up to August 2016, with no restriction of date or language. The search targeted studies that presented data on the time of occurrence of ankle sprains during sports matches. Data from included studies were analyzed as a percentage of ankle sprain occurrence by halftime and by quarters. Meta-analyses were run using a random effects model. The quality assessment tool for quantitative studies was used to assess the article’s quality. Evidence Synthesis: The searches identified 1142 studies, and 8 were included in this review. A total of 500 ankle sprains were reported during follow-up time, which ranged from 1 to 15 years, in 5 different sports (soccer, rugby, futsal, American football, and Gaelic football). The meta-analyses, including all 8 studies, showed that the proportion of ankle sprains during the first half (0.44; 95% confidence interval [CI], 0.38–0.50) was smaller than the second half (0.56; 95% CI, 0.50–0.62). For the analyses by quarters, the proportion of ankle sprains in the first quarter (0.14; 95% CI, 0.09–0.19) was considerably smaller than the second (0.28; 95% CI, 0.24–0.32), third (0.25; 95% CI, 0.17–0.34), and fourth (0.29; 95% CI, 0.22–0.36) quarters. Conclusion: The results of this review indicate that ankle sprains are more likely to occur later in the game during the second half or during the latter minutes of the first half.
Guilherme S. Nunes, Igor Yamashitafuji, Bruna Wageck, Guilherme Garcia Teixeira, Manuela Karloh and Marcos de Noronha
Context: The treatment of edema after a knee injury is usually 1 of the main objectives during rehabilitation. To assess the success of treatment, 2 methods are commonly used in clinical practice: volumetry and perimetry. Objective: To investigate the intra- and interassessor reliability of volumetry and perimetry to assess knee volume. Design: Cross-sectional. Setting: Laboratory. Participants: 45 health participants (26 women) with mean age of 22.4 ± 2.8 y. Main Outcome Measures: Knee volume was assessed by 3 assessors (A, B, and C) with 3 methods (lower-limb volumetry [LLV], knee volumetry [KV], and knee perimetry [KP]). Assessor A was the most-experienced assessor, and assessor C, the least experienced. LLV and KV were performed with participants in the orthostatic position, while KP was performed with participants in supine. Results: For the interassessor analysis, the ICC2,1 was high (.82) for KV and very high for LLV (.99) and KP (.99). For the intra-assessor analysis, ICC2,1 ranged from moderate to high for KV (.69-.83) and was very high for LLV (.99) and KP (.97-.99). Conclusion: KV, LLV, and KP are reliable methods, both intra- and interassessor, to measure knee volume.