Publications by authors named "Rodrigo Scattone Silva"

24 Publications

  • Page 1 of 1

Association of Ankle Dorsiflexion and Landing Forces in Jumping Athletes.

Sports Health 2021 Dec 27:19417381211063456. Epub 2021 Dec 27.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.

Background: Dorsiflexion range of motion restriction has been associated with patellar tendinopathy, but the mechanisms of how dorsiflexion restriction could contribute to knee overload remain unknown.

Hypothesis: Peak ankle dorsiflexion and ankle dorsiflexion excursion are negatively associated with peak vertical ground-reaction force (vGRF) and loading rate, and with peak patellar tendon force and loading rate, and positively associated with peak ankle plantar flexor moment.

Study Design: Cross-sectional study.

Level Of Evidence: Level 4.

Methods: Kinematic and kinetic data of 26 healthy recreational jumping athletes were measured during a single-leg drop vertical jump. Pearson's correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and ankle dorsiflexion excursion with peak vGRF and vGRF loading rate, with peak patellar tendon force and patellar tendon force loading rate, and with peak ankle plantar flexor moment.

Results: Ankle dorsiflexion excursion negatively correlated with peak vGRF loading rate ( = -0.49; = 0.011) and positively correlated with peak ankle flexor plantar moment ( = 0.52; = 0.006). In addition, there was a positive correlation between peak ankle dorsiflexion and peak vGRF ( = 0.39; = 0.05).

Conclusion: Ankle kinematics are associated with vGRF loading rate, ankle flexor plantar moment and peak vGRF influencing knee loads, but no association was observed between ankle kinematics and patellar tendon loads.

Clinical Relevance: These results suggest that increasing ankle dorsiflexion excursion may be an important strategy to reduce lower limb loads during landings but should not be viewed as the main factor for reducing patellar tendon force.
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http://dx.doi.org/10.1177/19417381211063456DOI Listing
December 2021

Preventive effect of tailored exercises on patellar tendinopathy in elite youth athletes: A cohort study.

Phys Ther Sport 2022 Jan 20;53:60-66. Epub 2021 Nov 20.

Tendon Research Group - Brazil, Fortaleza, CE, Brazil; Physical Therapy Department - Universidade Federal Dos Vales Do Jequitinhonha e Mucuri, Brazil; Programa de Pós-Graduação Em Reabilitação e Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha e Mucuri, Diamantina, Brazil. Electronic address:

Objective: To investigate the effects of an intervention with tailored exercises on the incidence of patellar tendinopathy (PT) in elite youth jumping athletes.

Design: Prospective crossover cohort.

Setting: One sport club facility.

Participants: 271 elite youth basketball and volleyball player were followed in the first year of the study (Observation year) and 270 athletes were followed in the second year (intervention year).

Main Outcome Measure: Incidence rates of PT per 1,000h of exposure. Cox survival analysis was used to verify the effects of the intervention (exercises implemented according to the findings of a preseason assessment) on PT incidence.

Results: The exercise prevention program significantly reduced the number of cases of PT, with athletes submitted to the intervention showing 51% less risk of developing PT. The overall PT incidence in the Observation year (5.9 per 1,000h of exposure) was significantly higher than that in the intervention year (2.8 per 1,000h of exposure) (P = .037). Twenty-six athletes developed PT in the observation year, whereas 13 athletes developed PT in the intervention year.

Conclusions: A tailored preventive program may be able to reduce the incidence of patellar tendinopathy, especially in male youth volleyball athletes. Randomized controlled trials are encouraged to confirm these findings.
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http://dx.doi.org/10.1016/j.ptsp.2021.11.006DOI Listing
January 2022

Simple verbal instructions are able to improve quality of movement during the lateral step-down test in healthy females.

J Bodyw Mov Ther 2021 Jul 8;27:207-215. Epub 2021 Mar 8.

Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi. Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil; Tendon Research Group-Brazil, Department of Physical Therapy, Federal University of Ceará, Fortaleza, CE, Brazil. Electronic address:

Introduction: Altered movement patterns during weight-bearing activities have been associated with knee injuries and can be clinically assessed using the lateral step-down test (LSD). It is possible that verbal feedback can improve movement patterns, but it remains unknown whether verbal feedback can improve movement quality during the LSD.

Purpose: To investigate whether verbal feedback can immediately improve visual movement quality and trunk, pelvis and lower limb kinematics in healthy females during the LSD.

Methods: 34 healthy females were assessed visually and with 3D kinematics while performing the LSD. Participants were divided into Good Movement Group (GG; n = 18) and Poor Movement Group (PG; n = 16) based on the LSD score. The feedback involved verbal instructions aimed at improving trunk, pelvis, hip and knee alignment during the test. Lower limb flexibility and strength were assessed for group comparisons and to investigate associations between all variables. Data analyses were performed using repeated-measures two-way ANOVAs and Spearman correlation tests.

Results: Feedback immediately improved movement quality, especially in participants of the GG [mean difference (MD) = 2.2 points; P < 0.001]. The PG showed greater pelvic drop (MD = 5.1°; P = 0.012), greater hip adduction (MD = 5.4°; P = 0.028) and less hip flexion (MD = 8.4°; P = 0.016) than the GG. Quality of movement had positive correlations with pelvic drop (r = 0.39; P = 0.02), hip adduction (r = 0.45; P = 0.01) and hip flexion (r = 0.49; P < 0.01) kinematics.

Conclusions: Verbal feedback improved movement quality during the LSD in healthy females. Females with worst movement quality showed greater pelvic drop and hip adduction, which are often found in individuals with knee disorders.
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http://dx.doi.org/10.1016/j.jbmt.2021.02.006DOI Listing
July 2021

Shockwave therapy associated with progressive exercises in rotator cuff tendinopathy: a clinical trial protocol.

Pain Manag 2021 Nov 9;11(6):639-646. Epub 2021 Jun 9.

Physioterapeutics Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Rod. "Washington Luis, km 235, Sao Carlos", São Paulo, Brazil.

The aim of the present study is to determine whether adding shockwave therapy (SWT) to a progressive exercise program improves shoulder pain and function in individuals with rotator cuff tendinopathy (RC tendinopathy). Ninety patients diagnosed with rotator cuff tendinopathy will be randomly allocated into two groups: active SWT plus a progressive exercise program or placebo SWT plus a progressive exercise program. Primary outcomes will be measured using the Constant-Murley Score function questionnaire and by assessing patient-reported pain intensity with the numerical pain rating scale. The secondary outcomes will be measured using the Global Perceived Effects Scale and Shoulder Pain and Disability Index. All the outcomes will be measured immediately after the end of treatment and at 3-month follow-up.
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http://dx.doi.org/10.2217/pmt-2020-0103DOI Listing
November 2021

Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial.

J Physiother 2021 04 20;67(2):132-139. Epub 2021 Mar 20.

Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte (UFRN), Santa Cruz, Rio Grande do Norte, Brazil. Electronic address:

Question: What are the effects of dry cupping on pain intensity, physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms and medication use in individuals with chronic non-specific low back pain?

Design: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of participants and assessors.

Participants: Ninety participants with chronic non-specific low back pain.

Interventions: The experimental group (n = 45) received dry cupping therapy, with cups bilaterally positioned parallel to the L1 to L5 vertebrae. The control group (n = 45) received sham cupping therapy. The interventions were applied once a week for 8 weeks.

Outcome Measures: Participants were assessed before and after the first treatment session, and after 4 and 8 weeks of intervention. The primary outcome was pain intensity, measured with the numerical pain scale at rest, during fast walking and during trunk flexion. Secondary outcomes were physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms and medication use.

Results: On a 0-to-10 scale, the between-group difference in pain severity at rest was negligible: MD 0.0 (95% CI -0.9 to 1.0) immediately after the first treatment, 0.4 (95% CI -0.5 to 1.5) at 4 weeks and 0.6 (95% CI -0.4 to 1.6) at 8 weeks. Similar negligible effects were observed on pain severity during fast walking or trunk flexion. Negligible effects were also found on physical function, functional mobility and perceived overall effect, where mean estimates and their confidence intervals all excluded worthwhile effects. No worthwhile benefits could be confirmed for any of the remaining secondary outcomes.

Conclusion: Dry cupping therapy was not superior to sham cupping for improving pain, physical function, mobility, quality of life, psychological symptoms or medication use in people with non-specific chronic low back pain.

Protocol Registration Number: NCT03909672.
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http://dx.doi.org/10.1016/j.jphys.2021.02.013DOI Listing
April 2021

Effects of dry cupping on pain, function and quality of life in women with knee osteoarthritis: a protocol for a sham-controlled randomised trial.

BMJ Open 2020 12 24;10(12):e039857. Epub 2020 Dec 24.

Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte (UFRN/FACISA), Santa Cruz, Brazil

Introduction: Knee osteoarthritis (KOA) is the most common cause of pain and disability worldwide. Dry cupping has been used as non-pharmacological approach to control pain and improve physical function. However, there is a lack of high-quality scientific evidence regarding its effects on this condition. This protocol describes a sham-controlled, randomised and simple blind study that aims to evaluate the effect of dry cupping on pain, function and quality of life in women with KOA.

Methods And Analysis: Sixty-two women diagnosed with KOA, based on American College of Rheumatology clinical criteria, and aged from 50 to 75 years, will be randomly distributed into two groups (31 per group): real and sham dry cupping. Both applications will occur with acrylic cups around the knee. The intervention will last 15 min, two times a week over six consecutive weeks, for a total of 12 sessions. Both groups will be assessed at four different times: before the intervention (T0), after 3 weeks intervention (T3), at the end of the protocol (T6) and 4 weeks after the interventions (follow-up: T10). The primary outcome will be pain intensity (Numerical Pain Rating Scale), and secondary outcomes will be knee-related health status (Western Ontario and McMaster Universities Osteoarthritis Index), functional capacity (8-step stair climb test, 40-metre fast-paced walk test and 30-second chair stand test), quality of life (Short-Form 36) and global perceived effect.

Ethics And Dissemination: This protocol was approved by the UFRN/FACISA Ethics Committee (number 3.737.688). The study results will be disseminated to the participants and submitted to a peer-reviewed journal and scientific meetings.

Trial Registration Number: NCT04331158.
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http://dx.doi.org/10.1136/bmjopen-2020-039857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768956PMC
December 2020

Does current evidence support the use of kinesiology taping in people with knee osteoarthritis?

Explore (NY) 2021 Nov-Dec;17(6):574-577. Epub 2020 Aug 6.

Federal University of Rio Grande do Norte, Santa Cruz, Brazil.

Objective: To analyze the current evidence about the effects of kinesiology taping (KT) with different amounts of tension in people with knee osteoarthritis (OA).

Data Sources: MEDLINE (via PUBMED), SciELO, COCHRANE Library, Scopus, PEDro, Web of Science and EMBASE were used as search databases.

Study Selection: Two independent researchers searched these databases from inception until June 2020 using the descriptors "kinesiotaping", "kinesio taping", "kinesiotape", "tape", "taping", "kinesiology taping", "kinesiology tape", "kinesthetic taping" or "elastic therapeutic tape" associated with "knee osteoarthritis". We included clinical trials that compared the application of KT with and without tension in people with knee OA.

Date Extraction And Quality Analysis: Data extraction included sample description, KT tension used in the study groups, duration of KT application, area of KT application, outcome measures and study methodological quality. The quality of the studies was evaluated by means of the Physiotherapy Evidence Database (PEDro) score.

Data Synthesis: Of the 850 studies identified, eight met the inclusion criteria and were ultimately included in this review. Most studies had moderate quality, with a satisfactory PEDro score. Results showed that KT application with tension was not superior to the application without tension for the outcomes of pain, physical function, range of motion and muscle strength. Evidence for edema, balance and quality of life is still limited.

Conclusion: Current evidence does not support the use of kinesiology taping in people with knee OA.
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http://dx.doi.org/10.1016/j.explore.2020.08.001DOI Listing
August 2020

Y-Balance Test Asymmetry and Frontal Plane Knee Projection Angle During Single-leg squat as Predictors of Patellofemoral Pain in Male Military Recruits.

Phys Ther Sport 2020 Jul 29;44:121-127. Epub 2020 May 29.

Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Universidade Federal do Rio Grande do Norte, Rua Vila Trairi, S/N, Centro, Santa Cruz, RN, CEP: 59200-000, Brazil. Electronic address:

Objectives: Investigate prospectively whether dynamic balance and frontal plane knee projection angle (FPKPA) are risk factors for the development of patellofemoral pain (PFP) in male military recruits.

Study Design: Prospective cohort.

Setting: Military training center.

Participants: 135 male military recruits were followed prospectively for six weeks and the incidence of PFP was documented.

Main Outcomes: Baseline measures of the Y-Balance test (YBT) and two-dimensional FPKPA during single-leg squatting were recorded. Mann-Whitney U tests and logistic regression analysis were utilized to identify possible variables associated with the development of PFP.

Results: A total of 14 male recruits developed PFP during the follow up period. The PFP group had significantly greater asymmetry on the YBT posterolateral direction (mean difference = 3.44 ± 0.57 cm; 95% Confidence Interval [CI] = 2.38-4.51 cm) and greater FPKPA during single-leg squat (mean difference = 5.55°±1.78°; [CI] = 1.81-9.28°) at baseline when compared to controls. Binary logistic regression models revealed that YBT posterolateral asymmetry ≥4.08 cm (Nagelkerke R = 0.304; X = 21.63; p < 0.001; OR = 5.46; [CI] = 4.47-8.06) and FPKPA ≥ 4.81° (Nagelkerke R = 0.249; X = 17.46; p < 0.001; OR = 4.65; [CI] = 3.32-9.06) were significantly associated with PFP.

Conclusions: Male military recruits with greater asymmetry on the YBT posterolateral direction and FPKPA were at a greater risk of developing PFP.
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http://dx.doi.org/10.1016/j.ptsp.2020.05.011DOI Listing
July 2020

Injury Profile in a Brazilian First-Division Youth Soccer Team: A Prospective Study.

J Athl Train 2020 Mar 22;55(3):295-302. Epub 2020 Jan 22.

Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil.

Context: Despite the popularity of soccer at the male first-division youth level, data on the incidence of injuries in Brazil are limited.

Objective: To prospectively study the injury profile of male first-division youth soccer players during 1 season (January to December 2017).

Design: Descriptive epidemiology study.

Setting: Data compiled at a youth soccer academy.

Patients Or Other Participants: The study involved 228 players between 10 and 20 years old from a first-division Brazilian soccer academy.

Main Outcome Measure(s): Injury incidence rate was reported as the number of injuries divided by overall exposure (training and match hours) multiplied by 1000. The rate ratio (injury incidence rate during matches in relation to training) was also calculated. Time-loss injuries (ie, physical complaints sustained during soccer matches or training that resulted in a player being unable to take part in soccer training or match play) during the season were recorded.

Results: A total of 187 injuries were documented in 122 players (65.2%). During the season, 100 389 hours of exposure (5995 hours of match play and 94 394 of training) were registered. The overall injury incidence rate was 1.86 per 1000 hours. In total, 4792 days were lost from soccer activities. The majority of injuries were noncontact thigh muscle disorders and ankle sprains. Injury incidence was greater in matches than in training, and the oldest age group (under 20 years old) had the highest injury incidence rate in matches, while the under 17-year-old group had the highest injury incidence rate in training sessions (22.48 and 3.05 per 1000 hours, respectively).

Conclusions: Muscle injury incidence rates observed among Brazilian soccer athletes under 20 years old were similar to those reported in professional players. Preventive measures are recommended to reduce injury rates. Additionally, the number of injuries incurred during training was high compared with match play, and training programs need to be assessed so that injury prevention can be improved.
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http://dx.doi.org/10.4085/1062-6050-449-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093922PMC
March 2020

Dry cupping in the treatment of individuals with non-specific chronic low back pain: a protocol for a placebo-controlled, randomised, double-blind study.

BMJ Open 2019 12 22;9(12):e032416. Epub 2019 Dec 22.

Postgraduate Program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz, Rio Grande do Norte, Brazil

Background: Low back pain is a very prevalent condition in the population and cupping therapy has been presented as a frequently used non-pharmacological treatment in this population. However, there is a lack of well-designed studies that evaluate the effects of this technique. This protocol describes a placebo-controlled, randomised, double-blind study that aims to evaluate the effect of dry cupping therapy on pain, physical function, trunk range of motion, quality of life and psychological symptoms in individuals with non-specific chronic low back pain.

Methods And Analysis: Ninety individuals with chronic non-specific low back pain, aged from 18 to 59 years, will be randomised into two groups: intervention group, which will be submitted to dry cupping therapy application with two suctions; and placebo group which will undergo placebo dry cupping therapy. Both applications will occur bilaterally in parallel to the vertebrae from L1 to L5. The application will be performed once a week for 8 weeks. The volunteers will be evaluated before the treatment (T0), immediately after the first intervention (T1), after 4 weeks of intervention (T4) and after 8 weeks of intervention (T8). The primary outcome will be pain intensity, and secondary outcomes will be physical function, lumbar range of motion, patient expectation, overall perception of effect, quality of life and psychological factors.

Ethics And Dissemination: This protocol has been approved by the Ethics Committee of FACISA/UFRN (number: 3639814). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings.

Trial Registration Number: NCT03909672.
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http://dx.doi.org/10.1136/bmjopen-2019-032416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937004PMC
December 2019

Effects of insoles adapted in flip-flop sandals in people with plantar fasciopathy: a randomized, double-blind clinical, controlled study.

Clin Rehabil 2020 Mar 6;34(3):334-344. Epub 2019 Dec 6.

Faculty of Health Sciences of Trairi (FACISA), Federal University of Rio Grande do Norte (UFRN), Santa Cruz, Brazil.

Objective: To evaluate the effects of insoles adapted into flip-flop sandals on pain and function in individuals with plantar fasciopathy (PF).

Design: Randomized, double-blind controlled study.

Setting: Physiotherapy clinic of the Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil.

Subjects: Sixty-six patients of both genders with PF were randomized into two groups: sandal insole group (SI;  = 34), which received a pair of custom flip-flop sandals with insoles covered with smooth synthetic leather; and plain sandal group (PS;  = 32), which received an identical pair of flip-flop sandals, but without the insoles.

Interventions: Patients were instructed to wear the flip-flops for 12 weeks for at least 4 hours/day.

Main Measures: Pain (visual analogue scale-VAS) in the morning and at the end of the day were considered primary outcomes. Function (Foot Function Index-FFI and Foot and Ankle Ability Measure-FAAM) and functional capacity (6-minute walk test-6MWT) were considered secondary outcomes. The outcomes were evaluated at baseline and immediately after the intervention by a blind assessor.

Results: Between-group differences were observed in terms of morning pain (mean difference (MD) = -1.82 cm; 95% confidence interval (CI) = -3.3 to -0.3;  = 0.016) and function (MD = -0.10; 95% CI = -0.19 to -0.01;  = 0.023) after the interventions with the SI group showing superior improvements in comparison to the PS group.

Conclusion: The use of insoles adapted in flip-flop sandals for 12 weeks was effective at improving pain and function in individuals with PF.

Level Of Evidence: 1b.
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http://dx.doi.org/10.1177/0269215519893104DOI Listing
March 2020

Assessment of quality of movement during a lateral step-down test: Narrative review.

J Bodyw Mov Ther 2019 Oct 14;23(4):835-843. Epub 2019 May 14.

Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil; Tendon Research Group-Brazil, Fortaleza, Brazil. Electronic address:

Introduction: Altered lower limb movement patterns during weight-bearing activities have been described as risk factors for several injuries. The lateral step-down test (LSD) was developed to be a simple, clinician-friendly tool to facilitate the assessment of lower extremity quality of movement during a functional activity. However, there is still conflicting information across the literature regarding how the LSD should be performed.

Objective: To critically review the literature regarding the assessment of quality of movement using the LSD and to provide an overview of how this test has been used, describing confounding factors and factors associated with altered movement patterns.

Methods: A literature review was conducted in PubMed/MEDLINE, COCHRANE, PEDro, SciELO and LILACS databases, by two independent reviewers.

Results: Sixteen articles met the inclusion criteria. One was a prospective cohort study to identify risk factors for injuries in military recruits. The fifteen remaining were cross-sectional studies involving healthy military recruits, physically active individuals, athletes and/or sedentary subjects, as well as participants with knee and ankle disorders. Worst quality of movement during the LSD has been associated with deficits in hip external rotation and knee extension strength as well as in ankle dorsiflexion range of motion. The reliability of the LSD has been reported to be moderate (κ = 0.59-0.81).

Conclusions: The LSD has adequate reliability and is a simple tool that can be used to quantify lower extremity quality of movement. Future studies should include standardized methods for application, scoring and interpretation of the test, so that confounding factors can be minimized.
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http://dx.doi.org/10.1016/j.jbmt.2019.05.012DOI Listing
October 2019

Relationship between the architecture and function of ankle plantar flexors with Achilles tendon morphology in ballet dancers.

Hum Mov Sci 2019 Oct 18;67:102494. Epub 2019 Jul 18.

Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil. Electronic address:

Achilles tendinopathy is the most frequent foot overuse injury in ballet dancers and knowledge of clinically modifiable factors related to tendon structure in a population at risk, such as ballet dancers, would be important for the development of preventive programs. Therefore, the present study aimed to assess relationships of gastrocnemius muscle architecture and ankle plantar flexors function with Achilles tendon morphology in ballet dancers. Fifty-four measures from 27 ballet dancers were collected. Tendon morphology (thickness, echogenicity, hypoechoic areas and neovascularisation) and muscle architecture (thickness, pennation angle and fascicle length) were evaluated using ultrasonography; ankle plantar flexors torque was evaluated using hand-held dynamometry, flexibility was evaluated in maximal weight-bearing ankle dorsiflexion position using inclinometer, and endurance was evaluated using the heel rise test. Ankle plantar flexors torque and medial gastrocnemius muscle architecture (thickness, pennation angle and fascicle length) are associated with Achilles tendon thickness in ballet dancers (r = 0.24, p = 0.008). Ankle plantar flexors torque and medial gastrocnemius muscle fascicle length are also associated with the echogenicity of the Achilles tendon (r = 0.13, p = 0.03). These findings call attention to the potential importance of ankle plantar flexors muscle force in healthy ballet dancers for the prevention of alterations in Achilles tendon structure.
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http://dx.doi.org/10.1016/j.humov.2019.102494DOI Listing
October 2019

Comparison of the effects of fatigue on kinematics and muscle activation between men and women after anterior cruciate ligament reconstruction.

Phys Ther Sport 2018 May 5;31:29-34. Epub 2018 Feb 5.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil. Electronic address:

Objectives: Studies comparing the effects of fatigue between men and women after anterior cruciate ligament (ACL) reconstruction are lacking. The purpose of this study was to compare the effects of muscle fatigue on trunk, pelvis and lower limb kinematics and on lower limb muscle activation between male and female athletes who underwent ACL reconstruction.

Design: Cross-sectional study.

Setting: Laboratory setting.

Participants: Fourteen recreational athletes (7 males and 7 females) with unilateral ACL reconstruction participated of this study.

Main Outcome Measures: Trunk, pelvis and lower limb kinematics and muscle activation of the vastus lateralis, gluteus medius and gluteus maximus were evaluated during a single-leg drop vertical jump landing before and after a fatigue protocol.

Results: Females had greater peak knee abduction after fatigue in relation to before fatigue (P = 0.008), and in relation to men after fatigue (P = 0.011). Also, in females, peak knee abduction was greater in the reconstructed limb in relation to the non-reconstructed limb after fatigue (P = 0.029). Males showed a greater mean amplitude of activation of the vastus lateralis muscle after fatigue in relation to before fatigue (P < 0.001).

Conclusions: Muscle fatigue produced kinematic alterations that have been shown to increase the risk for a second ACL injury in female athletes.
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http://dx.doi.org/10.1016/j.ptsp.2018.01.009DOI Listing
May 2018

Methods to assess patellofemoral joint stress: A systematic review.

Gait Posture 2018 Mar 17;61:188-196. Epub 2017 Dec 17.

Department of Community and Allied Health, La Trobe University, Bendigo, VIC, Australia.

Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.
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http://dx.doi.org/10.1016/j.gaitpost.2017.12.018DOI Listing
March 2018

Effects of Altering Trunk Position during Landings on Patellar Tendon Force and Pain.

Med Sci Sports Exerc 2017 Dec;49(12):2517-2527

1Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, BRAZIL; 2Department of Physiotherapy, Federal University of São Carlos, São Carlos, BRAZIL; 3Department of Physical Therapies, Australian Institute of Sport, Canberra, AUSTRALIA; 4Department of Physiotherapy, Faculty of Health, University of Canberra, Canberra, AUSTRALIA; 5Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, AUSTRALIA; 6Movement Science, Australian Institute of Sport, Canberra, AUSTRALIA; and 7Canberra Specialist Ultrasound, Canberra, AUSTRALIA.

Purpose: This study aimed to verify the immediate effects of altering sagittal plane trunk position during jump landings on lower limb biomechanics, patellar tendon force, and pain of athletes with and without patellar tendinopathy.

Methods: Twenty-one elite male athletes were categorized into three groups: athletes with patellar tendinopathy (TG; n = 7), asymptomatic athletes with patellar tendon abnormalities (n = 7), and asymptomatic athletes without tendon abnormalities (CG; n = 7). A biomechanical evaluation was conducted while the athletes performed drop landings from a bench in a self-selected trunk position (SS). Afterward, the athletes were randomly assigned to land with either a flexed trunk position (FLX) or an extended trunk position (EXT). Variables of interest for this study included sagittal plane peak kinematics, kinetics, patellar tendon force, and pain during the landing tasks.

Results: Peak patellar tendon force, knee extensor moment, and knee pain decreased in the FLX landing compared with the SS landing, regardless of group. In addition, peak patellar tendon force, knee extensor moment, and vertical ground reaction force were smaller in the FLX landing compared with the EXT landing. The TG had smaller peak ankle dorsiflexion compared with the CG during jump landings, regardless of trunk position.

Conclusions: Landing with greater trunk flexion decreased patellar tendon force in elite jumping athletes. An immediate decrease in knee pain was also observed in symptomatic athletes with a more flexed trunk position during landing. Increasing trunk flexion during landing might be an important strategy to reduce tendon overload in jumping athletes.
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http://dx.doi.org/10.1249/MSS.0000000000001369DOI Listing
December 2017

Lower limb strength and flexibility in athletes with and without patellar tendinopathy.

Phys Ther Sport 2016 Jul 19;20:19-25. Epub 2015 Dec 19.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil. Electronic address:

Objectives: To compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls.

Design: Cross-sectional study.

Setting: Laboratory setting.

Participants: Fourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7).

Main Outcome Measures: Hip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer.

Results: The TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828).

Conclusions: Strength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy.
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http://dx.doi.org/10.1016/j.ptsp.2015.12.001DOI Listing
July 2016

Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up.

J Orthop Sports Phys Ther 2015 Nov 21;45(11):899-909. Epub 2015 Sep 21.

Study Design Case report. Background Although eccentric exercises have been a cornerstone of the rehabilitation of athletes with patellar tendinopathy, the effectiveness of this intervention is sometimes less than ideal. Athletes with patellar tendinopathy have been shown to have different jump-landing patterns and lower hip extensor strength compared to asymptomatic athletes. To our knowledge, the effectiveness of an intervention addressing these impairments has not yet been investigated. Case Description The patient was a 21-year-old male volleyball athlete with a 9-month history of patellar tendon pain. Pain was measured with a visual analog scale. Disability was measured with the Victorian Institute of Sport Assessment-patella questionnaire. These assessments were conducted before and after an 8-week intervention, as well as at 6 months after the intervention. Hip and knee kinematics and kinetics during drop vertical jump and isometric strength were also measured before and after the 8-week intervention. The intervention consisted of hip extensor muscle strengthening and jump landing strategy modification training. The patient did not interrupt volleyball practice/competition during rehabilitation. Outcomes After the 8-week intervention and at 6 months postintervention, the athlete was completely asymptomatic during sports participation. This favorable clinical outcome was accompanied by a 50% increase in hip extensor moment, a 21% decrease in knee extensor moment, and a 26% decrease in patellar tendon force during jump landing measured at 8 weeks. Discussion This case report provides an example of how an 8-week intervention of hip muscle strengthening and jump-landing modification decreased pain and disability and improved jump-landing biomechanics in an athlete with patellar tendinopathy. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(11):899-909. Epub 21 Sep 2015. doi:10.2519/jospt.2015.6242.
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http://dx.doi.org/10.2519/jospt.2015.6242DOI Listing
November 2015

Evaluating eccentric hip torque and trunk endurance as mediators of changes in lower limb and trunk kinematics in response to functional stabilization training in women with patellofemoral pain.

Am J Sports Med 2015 Jun 19;43(6):1485-93. Epub 2015 Mar 19.

Department of Physical Therapy University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Background: Altered movement patterns of the trunk and lower limbs have been associated with patellofemoral pain (PFP). It has been assumed that increasing the strength of the hip and trunk muscles would improve lower limb and trunk kinematics in these patients. However, evidence in support of that assumption is limited.

Purpose: To determine whether increases in the strength of hip muscles and endurance of trunk muscles in response to functional stabilization training will mediate changes in frontal plane lower limb kinematics in patients with PFP.

Study Design: Controlled laboratory study.

Methods: Thirty-one female athletes were randomized to either a functional stabilization training group that emphasized strengthening of the trunk and hip muscles or a standard training group that emphasized stretching and quadriceps strengthening. Patients attended a baseline assessment session, followed by 8 weeks of intervention, and were then reassessed at the end of the intervention period. The potential mediators that were evaluated included eccentric torque of hip muscles and endurance of the trunk muscles. The outcome variables were the lower limb and trunk kinematics in the frontal plane assessed during a single-legged squat task.

Results: The eccentric strength of the gluteus muscles showed a mediation effect ranging from 18% to 32% on changes to frontal plane kinematics (decreased ipsilateral trunk inclination, pelvis contralateral depression, and hip adduction excursions) observed in the functional stabilization training group after intervention.

Conclusion: Although the mediation effects were small, the results suggest that improvements in the strength of the gluteus muscles can influence the frontal plane movement patterns of the lower limb and trunk in women with PFP.

Clinical Relevance: Patients with PFP might benefit from strengthening of the hip muscles to improve frontal plane lower limb and trunk kinematics during functional tasks.
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http://dx.doi.org/10.1177/0363546515574690DOI Listing
June 2015

Forefoot varus predicts subtalar hyperpronation in young people.

J Am Podiatr Med Assoc 2014 Nov;104(6):594-600

Background: Subtalar joint hyperpronation is a foot misalignment that has been associated with several musculoskeletal injuries. Forefoot varus is thought to result in subtalar hyperpronation during weightbearing circumstances. However, few studies have aimed to verify whether there is a significant relationship between forefoot alignment and subtalar hyperpronation. Moreover, no study has attempted to verify whether forefoot varus can predict subtalar hyperpronation in young individuals. Therefore, the purpose of this study was to verify whether forefoot varus can predict subtalar hyperpronation, measured using the rearfoot eversion angle test, the navicular drop test, and the Foot Posture Index (FPI), in young people.

Methods: Fifty-four healthy adolescents volunteered for this study (28 boys and 26 girls). A single examiner evaluated the forefoot angle, rearfoot angle, navicular drop, and FPI of each participant. Statistical analysis included the Pearson correlation test and a linear regression analysis to establish the relationship between the variables.

Results: These results showed a high positive correlation between forefoot varus and rearfoot angle (r = 0.86; P < .001), navicular drop (r = 0.76; P < .001), and FPI (r = 0.82; P < .001). Moreover, the forefoot varus variable was able to predict 74% of the variability in the rearfoot angle, 58% in the navicular drop, and 67% in the FPI (P < .001).

Conclusions: These findings support previous assumptions that individuals with forefoot varus present subtalar hyperpronation. Clinicians should not overlook forefoot alignment when prescribing foot orthoses for treating patients with foot misalignments.
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http://dx.doi.org/10.7547/8750-7315-104.6.594DOI Listing
November 2014

Sex differences in trunk, pelvis, hip and knee kinematics and eccentric hip torque in adolescents.

Clin Biomech (Bristol, Avon) 2014 Nov 19;29(9):1063-9. Epub 2014 Aug 19.

Federal University of São Carlos, Department of Physical Therapy, São Carlos, SP, Brazil. Electronic address:

Background: Adolescents have a high incidence of knee joint dysfunctions, with up to 28% of adolescents reporting knee pain. Although adolescent females have a greater incidence of knee injuries in comparison to males, few studies conducted biomechanical evaluations in this population aiming to identify sex differences. If trunk and/or lower limb biomechanical impairments are identified in female adolescents, the implementation of early interventions for injury prevention will be better justified. The purpose of this study was to compare the trunk, pelvis, hip and knee kinematics during a single-leg squat task, as well as the isokinetic eccentric hip torque, between male and female healthy adolescents.

Methods: Forty-four healthy adolescents were divided into two groups, group of males (n=22) and group of females (n=22). Kinematics during single-leg squat were assessed using a electromagnetic tracking system. For the evaluation of eccentric hip torque in the three planes an isokinetic dynamometer was used. Group differences were assessed using a one-way multivariate analysis of variance.

Findings: Results showed that adolescent females presented greater hip adduction, hip external rotation and knee abduction, as well as smaller trunk flexion during single-leg squat in comparison to males. Additionally, adolescent females showed smaller isokinetic eccentric hip torque normalized by body mass in all planes in comparison to males.

Interpretation: These sex differences in terms of trunk/lower limb kinematics and eccentric hip torque generation might play an important role in the greater incidence of overuse knee injuries observed in adolescent females.
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http://dx.doi.org/10.1016/j.clinbiomech.2014.08.004DOI Listing
November 2014

The effects of forefoot varus on hip and knee kinematics during single-leg squat.

Man Ther 2015 Feb 12;20(1):79-83. Epub 2014 Jul 12.

Federal University of São Carlos, Department of Physical Therapy, São Carlos, SP, Brazil. Electronic address:

Foot misalignments, such as forefoot varus (FV), have been associated with musculoskeletal injuries in the proximal joints of the lower limb. Previous theories suggested that this association occurs because FV influences knee and hip kinematics during closed kinetic chain activities. However, research on the effects of FV in the kinematics of the lower limb is very scarce. Therefore, the purpose of this study was to compare the knee and hip kinematics between subjects with and without FV during a functional weight-bearing activity. Forty-six healthy adolescents were divided into two groups: group of subjects with FV (VG, n = 23) and group of subjects with aligned forefoot (CG, n = 23). A kinematic evaluation was conducted while the subjects performed a single-leg squat task. The variables of interest were hip internal rotation and adduction and knee abduction excursions at 15°, 30°, 45° and 60° of knee flexion. Between-group comparisons were performed with multivariate analysis of variance. Results showed that the VG presented greater hip internal rotation when compared with the CG across all evaluated knee flexion angles (P = 0.02-0.0001). No differences between groups were observed in hip adduction or knee abduction (P > 0.05). These results indicate that FV influences the transverse plane hip movement patterns during a functional weight-bearing activity. Considering that excessive hip internal rotation has been associated with knee injuries, these findings might contribute for a better understanding of the link between FV and injuries of the proximal joints of the lower limb.
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http://dx.doi.org/10.1016/j.math.2014.07.001DOI Listing
February 2015

Effects of functional stabilization training on pain, function, and lower extremity biomechanics in women with patellofemoral pain: a randomized clinical trial.

J Orthop Sports Phys Ther 2014 04 25;44(4):240-251, A1-A8. Epub 2014 Feb 25.

Department of Physical Therapy, São Carlos Federal University, São Carlos, Brazil.

Study Design: Randomized clinical trial.

Objectives: To compare the effects of functional stabilization training (FST) versus standard training on knee pain and function, lower-limb and trunk kinematics, trunk muscle endurance, and eccentric hip and knee muscle strength in women with patellofemoral pain.

Background: A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain. However, there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity.

Methods: Thirty-one women were randomized to either the FST group or standard-training group. Patients attended a baseline assessment session, followed by an 8-week intervention, and were reassessed at the end of the intervention and at 3 months after the intervention. Assessment measures were a 10-cm visual analog scale for pain, the Lower Extremity Functional Scale, and the single-leg triple-hop test. A global rating of change scale was used to measure perceived improvement. Kinematics were assessed during the single-leg squat. Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment.

Results: The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the standard-training group. Lesser ipsilateral trunk inclination, pelvis contralateral depression, hip adduction, and knee abduction, along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat, were only observed in the FST group after the intervention. Only those in the FST group had greater eccentric hip abductor and knee flexor strength, as well as greater endurance of the anterior, posterior, and lateral trunk muscles, after training.

Conclusion: An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.
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http://dx.doi.org/10.2519/jospt.2014.4940DOI Listing
April 2014

The influence of forefoot varus on eccentric hip torque in adolescents.

Man Ther 2013 Dec 4;18(6):487-91. Epub 2013 Jun 4.

Federal University of São Carlos, Department of Physical Therapy, Rod. Washington Luís, Km 235 - CEP 13.565-905, São Carlos, SP, Brazil.

Hip strength impairments have been established as risk factors for lower limb injuries. Hip muscles strength might be influenced by foot misalignments, however this has not yet been verified. Forefoot varus (FV) has been shown to cause subtalar joint hyperpronation. Subtalar hyperpronation has been associated with excessive lower limb internal rotation in weight-bearing activities. Also, subtalar hyperpronation might result in greater ground reaction force dissipation at the foot. Consequently, there would be less demand for force dissipation at the hip joint, which could reduce the capacity for hip eccentric torque in these subjects. Therefore, the purpose of this study was to determine if FV influences the eccentric hip torque generation of young subjects. Forty-four sedentary, healthy adolescents were divided into 2 groups: subjects with FV (VG, n = 22) and subjects with neutral forefoot alignment (CG, n = 22). An isokinetic dynamometer was used to assess the eccentric torque generated in hip extension and external rotation in these subjects. Group differences were assessed using a one-way multivariate analysis of variance. The VG presented smaller eccentric torque for hip extension (P = 0.014) when compared to the CG, with no difference between groups in external rotation torque (P = 0.433). These results indicate that FV influences hip eccentric torque generation of young subjects. Considering that the muscles involved in hip extension are related to the stabilization of the lumbar spine, hip and knee, these findings bring further enlightenment to the role of foot misalignments as risk factors for injuries in the lower limbs and lumbo-pelvic complex in young subjects.
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http://dx.doi.org/10.1016/j.math.2013.05.001DOI Listing
December 2013
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