No abstract

Context: The effects of an exercise program (EP) for the treatment of patellofemoral pain syndrome (PFPS) are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. Objective: To evaluate the effects of OMT versus EP on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with PFPS. Design: This is a randomized controlled trial. Setting: Human performance laboratory. Participants: A total of 82 runners with PFPS participated in this study. Interventions: The participants were randomized into 3 groups: OMT, EP, and control group. The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. The EP group performed specific exercises for lower limbs. The control group received no intervention. Main Outcome Measures: The main evaluations were pain through the visual analog scale, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. Results: There was a significant pain decrease in the OMT and EP groups when compared with the control group. OMT group showed increased functionality, decreased PPMF, and increased PTF. The range of motion for hip extension increased only in the EP group. Conclusion: Both OMT and EP are effective in treating runners with PFPS.

Patients with chronic obstructive pulmonary disease (COPD) may have poor inspiratory muscle function, which reduces minute and alveolar ventilation, leading to increased hypoxemia and slow pulmonary oxygen uptake kinetics. However, little is known about the effect of inspiratory muscle weakness (IMW) on oxygen uptake kinetics in patients with COPD. Thus, we tested the hypothesis that COPD patients with IMW have slowed oxygen uptake kinetics. An observational study was conducted that included COPD patients with moderate to severe airflow limitation and a history of intolerance to exercise. Participants were divided into 2 groups: (IMW+; n = 22) (IMW-; n = 23) of muscle weakness. The maximal inspiratory, expiratory, and sustained inspiratory strength as well as the maximal endurance of the inspiratory muscles were lower in IMW+ patients (36 ± 9.5 cm HO; 52 ± 14 cm HO; 20 ± 6.5 cm HO; 94 ± 84 s, respectively) than in IMW- patients (88 ± 12 cm HO; 97 ± 28 cm HO; 82.5 ± 54 cm HO; 559 ± 92 s, respectively; p < 0.05). Moreover, the 6-min walk test and peak oxygen uptake were reduced in the IMW+ patients. During the constant work test, oxygen uptake kinetics were slowed in the IMW+ compared with IMW- patients (88 ± 29 vs 61 ± 18 s, p < 0.05). Our findings demonstrate that inspiratory muscle weakness in COPD is associated with slowed oxygen uptake kinetics, and thus, reduced functional capacity.

Background: Transcutaneous electrical nervous stimulation (TENS) and interferential electrical stimulation (IES) attenuates muscle metaboreflex by sympathetic nervous modulation. Objective: We tested the hypothesis that IES may be more effective than TENS to improves blood flow which may be linked to greater of deep tissue. Methods: Eleven health subjects were randomized to TENS (80 Hz, 150μs), IES (4000 Hz, ΔAMF=25 Hz) or sham stimulation group, during 30 minutes. The acute intervention was applied on stellate ganglion region (C7-T4). Results: Were measured metaboreflex activity by calf vascular resistance (CVR) and calf blood flow (CBF) and HRV during three times: rest, exercise (static handgrip) and postexercise circulatory occlusion (PECO+ and PECO-). At the exercise peak, compared with TENS and Sham, the IES group reduced CVR (36 ± 3 vs 43 ± 3; p<0.05) and increased CBF (p<0.01). Also, IES was associated with a greater reduction on the MMA (IES: 9 ± 2, TENS: 14 ± 4, Sham: 26 ± 5 units; p<0.01). Furthermore, the IES group had a higher reduction of LF/HF ratio during PECO- and PECO+ (p<0.05). Conclusion: The IES over the stellate ganglion region seems to have superior efficacy compared with TENS to attenuate metaboreflex activation and vasodilatory responses during exercise in healthy subjects.