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Introdução: O retalho transverso do músculo reto abdominal (TRAM) é um método de reconstrução mamária com bons resultados estéticos e dispensa o uso de próteses de silicone para melhor contorno corporal. Foi originalmente descrito por Holmstrom em 1979, como uma elipse de pele e gordura com base em um músculo isolado no seu pedículo vascular. A reconstrução sistematizada do defeito da parede instalado após a transposição do retalho com o uso de tela de polipropileno foi descrita em estudo prévio por Cunha. O artigo tem como objetivo avaliar as alterações na parede abdominal, após a sistematização da colocação da tela de polipropileno durante a cirurgia de reconstrução com TRAM. Método: É um trabalho de coorte retrospectivo que avalia as possíveis alterações da parede abdominal de pacientes submetidos ao retalho TRAM com tomografia computadorizada de abdome pré e pós-operatórias. Resultados: Foi evidenciada uma redução do tamanho da cavidade abdominal de, em média, 14,5% e 14,2% na espessura da parede abdominal submetidas ao TRAM. A maior redução da espessura da parede abdominal foi de um paciente submetido ao retalho bipediculado, com 50,7%. As complicações apresentadas foram hérnia umbilical, seroma tardio, fibrose peritela e granuloma de fio. Conclusão: Nesse estudo, a tomografia após a cirurgia demonstrou a redução no volume da cavidade abdominal e espessura da parede abdominal, o que não influenciou estatisticamente no aparecimento de hérnia abdominal, abaulamentos, extrusão da malha ou outras deformidades.

Introduction: The transverse rectus abdominis muscle flap (TRAM) is a method of breast reconstruction with good aesthetic results and does not require the use of silicone implants for better body contouring. It was originally described by Holmstrom in 1979 as an ellipse of skin and fat based on an isolated muscle on its vascular pedicle. The systematic reconstruction of the wall defect installed after flap transposition using polypropylene mesh was described in a previous study by Cunha. The article aims to evaluate changes in the abdominal wall, after the systematization of polypropylene mesh placement during TRAM reconstruction surgery. Method: This is a retrospective cohort study that evaluates possible changes in the abdominal wall of patients undergoing the TRAM flap with preand postoperative abdominal computed tomography. Results: A reduction in the size of the abdominal cavity of, on average, 14.5% and 14.2% in the thickness of the abdominal wall subjected to TRAM was evidenced. The greatest reduction in abdominal wall thickness was in a patient who underwent a bipedicled flap, with 50.7%. The complications presented were umbilical hernia, late seroma, perithellal fibrosis, and thread granuloma. Conclusion: In this study, tomography after surgery demonstrated a reduction in the volume of the abdominal cavity and thickness of the abdominal wall, which did not statistically influence the appearance of abdominal hernia, bulging, mesh extrusion, or other deformities.

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OBJECTIVE: The purpose of this study was to examine the immediate effects of lumbosacral orthosis and the abdominal drawing-in maneuver on the trunk postural control of adults with chronic low back pain compared with asymptomatic controls during 1-legged and semi-tandem stances. METHODS: An experimental and comparative study (cross-sectional design) was conducted in a laboratory setting. Twenty adults with chronic low back pain and 20 asymptomatic controls randomly performed 2 postural balance tasks over a force platform, considering 3 experimental conditions: (1) natural posture (baseline-control), (2) lumbosacral orthosis, and (3) abdominal drawing-in maneuver. Linear variables (mean amplitude, ellipse area, and sway velocity) derived from the center of pressure were computed, and 2-way analysis of variance (group × condition) for repeated measures were conducted. RESULTS: No group × condition interactions (.139 ≤ P ≤.938) were detected in any center of pressure parameters. No condition effect was detected, but a group effect (P = .042) was observed for 1 center of pressure parameter. The chronic low back pain group presented with a lower mean anteroposterior center of pressure amplitude than asymptomatic controls (∆ = 0.31 ± 0.66 cm [95% confidence interval, 0.05-0.56], P = .019) during the semi-tandem stance balance task. CONCLUSION: Neither lumbosacral orthosis nor the abdominal drawing-in maneuver showed immediate improvement in trunk postural control in any group. Thus, clinicians should not expect immediate benefits or improvements yielded by lumbosacral orthosis or the abdominal drawing-in maneuver when patients with chronic low back pain undergo these interventions.

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Although quadruped exercises (QE) have been a part of rehabilitation and sports programs, there is no clarity on how these exercises challenge the musculoskeletal system. Therefore, this cross-sectional study investigated the perceived exertion, postural demands, and muscle recruitment profiles imposed by three QE postures. Surface electromyographic (sEMG) signals were recorded from transverse abdominis, longissimus dorsi, multifidus, and iliocostalis lumborum from 30 sedentary healthy women, bilaterally. They performed the classic quadruped exercise (CQ), a variation with shoulder flexion (FQ), and the homolateral quadruped (HQ). Borg scores (BS) and the center of pressure (CoP) from the palmar statokinesiogram were also recorded. Surface EMG signals were normalized using the myoelectric activity recorded from two other postures while performing isometric voluntary contractions (IVC). Results were analyzed using one- (CoP) and three-way (sEMG data) ANOVA with Bonferroni post hoc tests (α = 0.05). The Borg scale was analyzed using the Friedman test. The CQ provided lower BS and CoP than HQ (p < 0.05), followed by a higher sEMG activity (∼51% of IVC) than FQ (∼47% of IVC; p = 0.53) and HQ (∼44% of IVC; p = 0.01). In turn, HQ provided greater BS (p > 0.05) than CQ and FQ. The results suggested that the HQ was the most challenging exercise regarding CoP and BS, although CQ presented a higher symmetrical sEMG activity. Since QE are often prescribed in exercise programs, specific knowledge of the characteristics of each QE makes prescribing safer and more efficient.

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OBJECTIVE: To assess the effect of pelvic patterns of proprioceptive neuromuscular facilitation (PNF-concept) on pelvic floor muscles (PFM) recruitment, as well as the electromyographic activity of muscles synergic to the pelvic floor in healthy women. METHODS: Observational study conducted with 31 women aged between 18 and 35 years, with mean age of 23.3 ± 3.2 (22.1-24.4). PFM activity was monitored by surface electromyography during the combination of isotonics technique of four pelvic patterns of PNF-concept (i.e., anterior elevation, posterior depression, anterior depression, and posterior elevation). The electromyographic signal was analyzed using root mean square amplitude. Two-way repeated measures analysis of variance was performed to analyze differences in PFM activity between types of contraction (i.e., concentric, isometric, and eccentric) and the four pelvic patterns. RESULTS: PFM activity did not differ among the four pelvic pattens. However, PFM activity was significantly different between the combination of isotonics technique and baseline, F(1.6, 48.2) = 71.5; p < 0.000, with a large effect size (partial ƞ² = 0.705). Concentric (22.4 µV ± 1.1), isometric (17.3 µV ± 0.6), and eccentric (15 µV ± 0.5) contractions of combination of isotonics technique increased PFM activity compared with baseline (10.8 µV ± 0.4) in all pelvic patterns. By analyzing the electromyographic activity of the muscles synergistic to the pelvic floor, there is effect of the interaction of the type of contraction, the pelvic pattern of the PNF concept, and the synergistic muscles on the myoelectric activity of the external anal sphincter, F(3.2, 96.5) = 5.6; p < 0.000, with a large magnitude of effect (partial ƞ² = 0.15). In the anterior elevation pattern, the muscles synergistic to the pelvic floor present synergy in phase with the PFM, and in the posterior patterns there was a decrease in the activity level of all synergistic muscles, without changing the activity level of the PFM. CONCLUSION: PFM activity did not differ among the four pelvic patterns of PNF-concept. Nonetheless, the combination of isotonics technique showed a significant effect on PFM compared with baseline, with greater PFM activity during concentric contraction. Pelvic patterns of PNF-concept may be used to increase PFM recruitment in young healthy women.

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ABSTRACT Objective: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). Method: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. Results: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Conclusion: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.

RESUMEN Objetivo: Evaluar el efecto de la electroestimulación abdominal (EE) sobre la frecuencia de las evacuaciones, la consistencia y la cantidad de heces en personas con estreñimiento debido a una lesión de la médula espinal (LME). Método: Estudio piloto experimental de tipo crossover-aleatorizado en dos grupos de tratamiento: convencional rehabilitación intestinal y convencional asociado a EE con Functional Electrical Stimulation (FES) de 8 y 20 Hz aplicados a los músculos abdominales. Se realizó un seguimiento de ambos grupos durante dos semanas con 30 minutos de sesión diaria de EE. Los participantes estaban hospitalizados en un instituto de rehabilitación de la ciudad de São Paulo. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: Diez personas con LME participaron en el estudio, la mayoría hombres (70%) con una edad media de 39 años (DE = 16,37). La EE asociada al tratamiento convencional demostró ser más eficaz en el aumento de la frecuencia de evacuación (p = 0,029) y la cantidad de heces (p = 0,031). Conclusión: La EE abdominal asociada al tratamiento convencional ayudó a aumentar la frecuencia de evacuación y la cantidad de heces en el contexto de estreñimiento en personas con LME. Este estudio piloto servirá de base para futuros ensayos clínicos con mayor muestreo y evidencia estadística.

RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.

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ABSTRACT Introduction Human motor dysfunction can affect the quality of life, especially waist dysfunction. And an effective means to improve muscle strength during exercise. Object This article compares and analyzes the effectiveness of human muscle exercise on the decline in quality of life caused by motor dysfunction. Method The article divides patients with motor dysfunction into trunk isokinetic training group (experimental group) and waist and abdominal muscle functional training group (control group), and comparative analysis of related indicators before and after treatment. Results Before treatment, the specific indicators of the two were different (P>0.05). After treatment, the patients' quality of life indicators and motor function indicators were significantly different (P<0.05). Conclusion Exercise has an obvious curative effect for patients with human motor dysfunction, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A disfunção motora humana pode afetar a qualidade de vida, principalmente a disfunção da cintura. E um meio eficaz de melhorar a força muscular é o exercício. Objetivo este artigo compara e analisa a eficácia do exercício muscular humano no declínio da qualidade de vida causado por disfunção motora. Método O artigo divide os pacientes com disfunção motora em grupo treinamento isocinético de tronco (grupo experimental) e grupo treinamento funcional de cintura e músculos abdominais (grupo controle), e análise comparativa dos indicadores relacionados antes e após o tratamento. Resultados Antes do tratamento, os indicadores específicos dos dois eram diferentes (P> 0,05). Após o tratamento, os indicadores de qualidade de vida e indicadores de função motora dos pacientes foram significativamente diferentes (P <0,05). Conclusão O exercício tem um efeito curativo óbvio para pacientes com disfunção motora humana e é digno de promoção clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La disfunción motora humana puede afectar la calidad de vida, especialmente la disfunción de la cintura. Y un medio eficaz para mejorar la fuerza muscular es el ejercicio. Objeto Este artículo compara y analiza la efectividad del ejercicio muscular humano sobre el deterioro de la calidad de vida causado por la disfunción motora. Método El artículo divide a los pacientes con disfunción motora en grupo de entrenamiento isocinético del tronco (grupo experimental) y grupo de entrenamiento funcional de cintura y músculos abdominales (grupo control), y análisis comparativo de indicadores relacionados antes y después del tratamiento. Resultados Antes del tratamiento, los indicadores específicos de los dos eran diferentes (P> 0.05). Después del tratamiento, los indicadores de calidad de vida de los pacientes y los indicadores de función motora fueron significativamente diferentes (P <0,05). Conclusión El ejercicio tiene un efecto curativo obvio para los pacientes con disfunción motora humana y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

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ABSTRACT Introduction: Sports muscle injury is a common phenomenon in sports, and most of it is caused by intense exercise done for a long time. Objective: The effect of high intensity mode (HI) speed endurance training on the muscle injury of athletes. Methods: 14 sprinters were recruited; the muscle injury indexes of the subjects were tested 15 min before and 24 h, 48 h and 72 h after speed endurance training in HV mode and HI mode (high volume mode and high intensity mode, respectively). Results: The results of this study showed that both high amount and HI mode speed endurance training caused a certain degree of injury to the subjects' muscles, but the injury caused by HI mode speed endurance training to the muscles was more serious than that caused by high amount (P < 0.05). Conclusions: HI mode speed endurance training causes a certain degree of injury to the subjects' muscle, but it causes more serious injury than high volume mode speed endurance training. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: As lesões musculares são fenômenos comuns no esporte e a maioria são causadas por exercícios intensos praticados por um longo período. Objetivo: O efeito do treinamento de resistência de velocidade de alta intensidade (AI) nas lesões musculares de atletas. Métodos: 14 corredores foram recrutados; os índices de lesão muscular dos indivíduos foram testados 15 minutos antes e 24h, 48h e 72h após o treino de resistência de velocidade em AV e AI (modos alto volume e alta intensidade, respectivamente). Resultados: Os resultados deste estudo mostram que tanto os treinamentos de resistência de velocidade nos modos alto volume e AI causaram certo grau de lesão aos músculos dos indivíduos, mas a lesão ao músculo por treino de resistência de velocidade no modo AI foi mais severa do que aquela no modo alto volume (P < 0.05). Conclusões: O treinamento de resistência de velocidade no modo AI causa certo grau de lesão aos músculos dos indivíduos, mas causa danos mais sérios do que o treino de resistência de velocidade no modo alto volume. Nível de evidência II; estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: Las lesiones musculares son fenómenos comunes en el deporte y la mayoría es causada por ejercicios intensos practicados por un largo periodo. Objetivo: El efecto del entrenamiento de resistencia de velocidad de alta intensidad (AI) en las lesiones musculares de atletas. Métodos: Se reclutaron 14 corredores; se testaron los índices de lesión muscular de los individuos 15 minutos antes y 24h, 48h y 72h después del entrenamiento de resistencia de velocidad en AV y AI (modos alto volumen y alta intensidad, respectivamente). Resultados: Los resultados de este estudio muestran que tanto los entrenamientos de resistencia de velocidad en los modos alto volumen y AI causaron cierto grado de lesión a los músculos de los individuos, pero la lesión al músculo por entrenamiento de resistencia de velocidad en el modo AI fue más severa que aquella en el modo alto volumen (P<0.05) Conclusiones: El entrenamiento de resistencia de velocidad en el modo AI causa cierto grado de lesión a los músculos de los individuos, pero causa daños más serios que el entrenamiento de resistencia de velocidad en el modo alto volumen. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

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ABSTRACT Introduction: Phosphate (CP) its biosynthesis begins with the kidney. Glycocianine was synthesized from glycocianine, then methylated in the liver, and finally formed in each tissue. Objective: To study the effects of phosphatic acid in exercise training. Methods: This paper uses 50 pure male mice, 2 month old, weight at 22 ± 3 g, and mice per day, 5 minutes each time. After exercise training, dry dry with a towel and blow it with a hair dryer, and move it to the end of each other. Results: The average time of motion B mouse to give phosphate creatine is significantly longer than the average time of the non-administration of the A group, and the motion time is prolonged to extend 23.20%. Phosphate has improved motor endurance and promotes improvement in muscle microcirculation during exercise. Conclusions: Motion can be used to improve the maximum aerobic capacity of exercise in motion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A biossíntese Its do fosfato começa no rim. Glicociamina foi sintetizado de glicocianina, e depois transformado em metilato no fígado; finalmente, desenvolve em cada tecido. Objetivo: Estudar os efeitos do ácido fosfato em treinamento de exercícios. Métodos: Este estudo usa 50 camundongos machos puros de dois meses de idade, pesando ± 3g aos 22 meses, e XXX camundongos por dia por cinco minutos cada vez. Após o treino, estes foram secos com uma toalha e secador de cabelo e colocados um do lado do outro. Resultados: O tempo médio de movimento para o grupo B de camundongos produzir fosfato de creatinina é consideravelmente mais longo do que o tempo médio do grupo A, onde não houve administração. O tempo de movimento se prolonga em 23,20%. O fosfato melhora a resistência motora e promove uma melhora na microcirculação durante o exercício. Conclusões: O movimento pode ser usado para melhorar a capacidade aeróbica máxima do exercício em movimento. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El biosíntesis del fosfato empieza en el riñón. La Glicociamina se sintetizó de Glicocianina, y después se transformó en metilato en el hígado; y finalmente, formó cada tejido. Objetivo: Estudiar los efectos del ácido fosfato en entrenamiento de ejercicios. Métodos: Este estudio utiliza 50 ratones machos puros de 2 meses de edad, pesando ± 3g a los 22 meses, y xxx ratones por día por 5 minutos cada vez. Tras el entrenamiento, se los secó con una toalla y secador de pelo y se los puso lado a lado. Resultados: El tiempo medio de movimiento para el grupo B de ratones producir fosfato de creatina es considerablemente más largo que el tiempo medio del grupo A, donde no hubo administración. El tiempo de movimiento se alarga en 23,20%. El fosfato mejora la resistencia motora y promueve una mejoría en la microcirculación durante el ejercicio. Conclusiones: El movimiento puede usarse para mejorar la capacidad aeróbica máxima del ejercicio en movimiento. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

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Abstract Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients. ClinicalTrials.gov Identifier: NCT04011436

Resumen Introducción. El síndrome de dolor pátelofemoral (SPF) es una de las alteraciones musculoesqueléticas más frecuentes que afectan la articulación de la rodilla. El tratamiento conservador reduce el dolor y mejora la capacidad funcional en el corto y mediano plazo. Objetivo. Establecer el efecto terapéutico de dos programas de ejercicios de fortalecimiento muscular en pacientes con SPF de Bogotá, Colombia, con edades entre 15 y 40 años. Materiales y métodos. Ensayo clínico controlado aleatorio experimental realizado en 40 pacientes con SPF de Bogotá, Colombia, con edades entre los 15 y 40 años, con nivel de actividad física leve a moderada y que fueron distribuidos de forma aleatoria en 2 grupos de intervención: Grupo A: programa de ejercicios de fortalecimiento de los músculos del core, la cadera y la rodilla con una duración de 8 semanas; Grupo B: programa de ejercicios de fortalecimiento de los músculos de la cadera y la rodilla con la misma duración. El nivel de dolor se midió a través de la Escala Visual Analógica y de la Escala de Kujala para dolor patelofemoral. Resultados. La adición de ejercicios de fortalecimiento de los músculos del core al tratamiento tradicional mejoró la calidad de vida de los participantes en el grupo de intervención A, donde se observó una reducción significativa del dolor con una diferencia estadísticamente significativa en la puntuación total de la escala Kujala (p=0.025). Conclusiones. Incluir ejercicios de fortalecimiento de los músculos del core al manejo conservador del SPF aumenta su efectividad para reducir el dolor y mejorar la calidad de vida de estos pacientes. ClinicalTrials.gov Identifier: NCT04011436

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AIMS: To compare the strength of abdominal and pelvic floor muscles (PFM) between nulliparous female athletes (FAs) and non-athletes (FNAs), to determine the frequency of urinary incontinence (UI) in these groups. METHODS: This cross-sectional comparative study of nulliparous women included 39 professional FAs, who competed at the district level or above, and 34 FNAs. Participants underwent pelvic floor and abdominal muscle assessments. PFM function and strength were assessed using the modified Oxford scale and a manometer (PERINA 996-2 QUARK). Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. The International Consultation on Incontinence Questionnaire-Short Form was used to assess UI symptoms among the athletes, and the International Physical Activity Questionnaire-Short Form was used to establish the level of physical activity among the non-athletes. RESULTS: The prevalence of UIs in the FAs was 53.8%, while that for FNAs was 35.3%. There was no association between being an athlete and having UI (p = 0.112). FAs were found to weigh more (p = 0.012) and have increased abdominal muscle strength (p = 0.014) and maximum voluntary PFM contraction as recorded by the manometer (p = 0.035), as well as a decreased PFM contraction endurance time (p = 0.025) than FNAs. CONCLUSION: FAs had stronger abdominal muscles and PFM contraction, as assessed by a manometer, but less PFM endurance when compared to FNAs. Despite these differences, the prevalence of UI was similar between groups.

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OBJECTIVES: To compare acute effects of isometric abdominal exercises performed with or without vibration on the electromyographic activity and cutaneous temperature in the abdominal region of physically active individuals. METHODS: A randomized controlled crossover clinical trial was undertaken in thirty volunteers who completed one unique session of two different protocols of interventions apart from a week from each other, in a two-week study protocol. The subjects were randomly divided in to two groups of 15 volunteers; both were assigned to perform board exercise (30 s on the front, right and left lateral boards, with a rest interval of 2 min). The first group performed it on a vibrating platform at a frequency of 30 Hz for the first week, while the remaining participants executed the same exercise without stimulates vibration. In the second week the protocol was inverted. The outcome were surface electromyography (EMG) data for the rectus abdominis muscle (RAM) and cutaneous temperature (CT) of the abdominal region. Normality was accepted, and Student's t-tests were used to compare the measurements for dependents variables (P < 0.05). RESULTS: There were no differences in RAM activation and CT between protocols with or without vibration (P > 0.05). CT increased (P = 0.001) after both the exercises with and without vibration. CONCLUSION: The results suggest that there were no effects in cutaneous temperature or muscle activation through the use of vibration associated with isometric abdominal exercises.

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OBJECTIVE: The purpose of this study was to determine the digital caliper's interrater reliability in measuring the interrecti distance and its accuracy in diagnosing the diastasis of the recti abdomini muscles (DRAM) in the third trimester of pregnancy compared with ultrasound. METHODS: Fifty-four pregnant women were included. Measurements were taken in supine, during trunk flexion and expiration, in the supraumbilical region, in the umbilical scar (US), and in the infraumbilical (IU) region, at first by ultrasonography (USG) and then by the 2 digital caliper's examiners. The 3 evaluators were independent and blind. RESULTS: In the interrecti distance measurement, comparing the 2 calipers' evaluators, the instrument showed an intraclass correlation coefficient (ICC) of 0.86 (95% CI: 0.72-0.92) in the supra-umbilical and ICC of 0.96 (95% CI: 0.92-0.98) in the US. Compared with the USG, the instrument showed the worst interrater reliability in the US (ICC -0.14; 95% CI: -0.39 to 0.13). In diagnosing DRAM, comparing calipers' evaluators, kappa was 0.56 (P < .01) for the IU region and 0.12 (P = .19) for the US region. When compared with the USG, kappa was 0.02 (P = .84) for the IU region and 0.05 (P = .59) for the US. In the US, the caliper presented a positive likelihood ratio of 1.05 (95% CI: 0.86-1.30) and a negative likelihood ratio of 0.63 (95% CI: 0.12-3.43). CONCLUSION: The digital caliper did not present good interrater reliability in measuring or in diagnosing the DRAM during the third trimester of pregnancy compared with ultrasound.

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Diversos processos fisiológicos, bem como alterações viscerais e osteomioarticulares, ocorrem durante a gestação e o parto e impactam de forma significativa o organismo feminino. A expansão do útero afeta a forma do abdome e a geometria dos músculos abdominais, os pesos do útero gravídico aumentam a pressão sobre a musculatura do assoalho pélvico com repercussões estéticas e funcionais. Objetivo: Revisar sistematicamente os estudos publicados nos últimos 10 anos a respeito das técnicas de reabilitação abdominal no pós-parto. Métodos: Foi realizada uma revisão sistemática da literatura, no período compreendido entre os anos de 2009 e 2019, nas bases de dados eletrônicas PubMed, BVS, Science Direct, PEDro. Resultados: Houve uma grande variabilidade em relação às intervenções utilizadas e aos desfechos analisados, sendo verificado estudos sobre flacidez abdominal, fibro edema gelóide, incontinência urinária persistente e tratamento para diástase do reto abdominal (DRA). Conclusão: De acordo com os resultados obtidos no presente estudo e baseados em estudos anteriores, conclui-se que os exercícios abdominais não apresentam mudança significativa para tratamento de IU; são necessários mais estudos para analisar quais tipos de exercícios são eficazes para tratamento de DRA; o aparelho que combina radiofrequência, infravermelho, massagem mecânica e endermologia tem influência positiva no tratamento de flacidez abdominal, fibro edema gelóide e lipodistrofia localizada. (AU)

Several physiological processes, visceral and osteomioarticular, occur during pregnancy and labor and impact significantly the female organism. The uterus expansion affects the abdomen shape and the abdominal muscles geometry, the pregnant uterus weight rises the pressure over the pelvic floor muscles with esthetic and functional repercussions. Objective: To review systematically studies published in the last 10 years about the techniques of abdominal rehabilitation on post childbirth. Methods: Systematic review of literature in the period between 2009 and 2019, on electronic data bases PubMed, BVS, Science Direct, PEDro. Results: There was a great variability in relation to the interventions used and the analyzed outcomes, being checked studies about abdominal flaccidity, fibrosis geloid edema, persistent urinary incontinence (UI) and abdominal rectus diastasis (ARD). Conclusion: According to the results obtained in the present study and based in previous studies, we conclude that abdominal exercises do not show significant change to UI treatment; more studies are necessary to analyze which exercises are effective to ARD treatment and if the machine that combines radiofrequency, infrared, mechanical massage and endermologie has positive influence on treatment for abdominal flaccidity, fibrosis geloid edema and localized lipodystrophy. (AU)

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BACKGROUND: A better understanding about the relationship between trunk and hip muscles strength and core stability may improve evaluation and interventions proposed to improve core stability. OBJECTIVES: To investigate if trunk and hip muscles strength predict pelvic posterior rotation during the bridge test with unilateral knee extension. METHODS: This is a cross-sectional study. Sixty-one healthy individuals of both sexes (age, 28±6.4 years, weight, 66.5±10.9kg, height, 167±9.5cm) performed the bridge test with unilateral knee extension. The pelvic posterior rotation during the bridge test was obtained with two-dimensional video analysis. Isometric strength of the trunk extensors and rotators, and hip abductors, external and internal rotators and extensors were measured with a hand-held dynamometer. Multiple linear regression analysis was performed to identify if the strength variables could explain the pelvic posterior rotation during the test. RESULTS: Muscle strength predicted pelvic posterior rotation during the bridge test (r=0.54; p=0.003). Strength of the trunk rotators (p=0.045) and hip internal rotators (p=0.015) predicted reduced magnitude of pelvic posterior rotation during the bridge test, and strength of the hip extensors (p=0.003) predicted increased magnitude of pelvic posterior rotation. CONCLUSIONS: Trunk rotators and hip internal rotators and extensors strength predict 29% of the performance during the bridge test with unilateral knee extension. The strength of these muscles should be evaluated in individuals with increased pelvic posterior rotation during the bridge test with unilateral knee extension.

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Introdução: A necessidade de oferecer resultados com maior definição nas abdominoplastias nos compele a evoluir tecnicamente. O objetivo deste trabalho é apresentar a técnica de plicatura em Crossbow com suas três variantes, reforçando o conceito de aproximação vertical e horizontal da aponeurose dos músculos retos e oblíquos abdominais ao mesmo tempo, promovendo dois vetores diferentes de tração, culminando em uma maior definição da parede abdominal, principalmente na região do hipogastro e fossas ilíacas. Métodos: No período entre janeiro de 2016 e fevereiro de 2018, foram realizadas 22 cirurgias exclusivamente com a técnica Crossbow em seus tipos l, ll e lll, tanto em pacientes estéticos como pós-bariátricos. Resultados: Os resultados foram favoráveis tanto do ponto de vista estético, com maior definição do hipogastro, como do ponto de vista clínico, uma vez que nenhum paciente apresentou sinais ou sintomas diferentes de técnicas convencionais. Conclusão: A técnica Crossbow é simples e reprodutível, sendo mais um agregante na armamentária para melhorar a estética abdominal. Apesar de promover o reforço da região hipogástrica, tanto para tratamento primário como secundário desta região, só o aumento da casuística poderá demonstrar as possíveis vantagens do método.

Introduction: Owing to the need to deliver results with greater definition in abdominoplasties, techniques must evolve. The objective of this study was to introduce the crossbow technique for plication along with its three variants that reinforces the concept of vertical and horizontal alignments of the aponeurosis of the rectus and oblique abdominis muscles at the same time, promotes 2 different traction vectors, and culminates in a greater definition of the abdominal wall, mainly in the hypogastrium and iliac fossa regions. Methods: From January 2016 to February 2018, 22 surgeries were performed exclusively with the types l, ll, or lll crossbow technique, both in esthetic surgery cases and post-bariatric patients. Results: The results were favorable both from the esthetic point of view, with greater definition of the hypogastrium, and from a clinical point of view, as none of the patients showed signs or symptoms different from those of the conventional techniques. Conclusion: The crossbow technique is a simple and reproducible tool in the medical armamentarium to improve abdominal esthetics. Although it promotes the strengthening of the hypogastric region, both for primary and secondary treatments of this region, only a sample size increase can demonstrate the possible advantages of the method.

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INTRODUCTION AND HYPOTHESIS: Studies have shown that there is a co-contraction between the pelvic floor and abdominal muscles. This study aimed to evaluate pelvic floor and abdominal muscle function in continent and incontinent female athletes and to investigate the association between these muscle groups. METHODS: This was a cross-sectional study. Forty nulliparous professional female athletes who competed at the municipal level or above participated in this study. All participants underwent a pelvic floor muscle (PFM) and abdominal muscle assessment. PFM function and strength were assessed using the modified Oxford Scale and a perineometer. Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. To assess athletes' urinary continence, the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-UI-SF) was used. RESULTS: There was a positive association between PFM and abdominal muscle strength among the incontinent athletes (p = 0.006; r = 0.577). The incontinent athletes had greater PFM strength than the continent athletes (p = 0.02). There was no difference in abdominal muscle function between the groups. CONCLUSIONS: We found that incontinent athletes have greater PFM strength than continent athletes. This suggests that urinary incontinence in this population is not due to PFM weakness. The positive association between abdominal and PFM strengths in incontinent athletes may be due to frequent co-contraction between these muscle groups.

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SUMMARY OBJECTIVE To evaluate pain, functional capacity, and quality of life of patients with non-specific chronic low back pain, after home-based exercise therapy with different kinds of supervision. METHOD Thirty individuals of both gender, between 18 and 65 years old, performed the proposed exercises three times a week, for eight weeks. Group A (N = 17) performed the exercises after a single supervised session. Group B (N = 13) was supervised once a week at the rehabilitation center. Both groups received a booklet with instructions, and questionnaires to evaluate pain, functional capacity and quality of life; during the initial evaluation, after four and eight weeks. RESULTS There was an improvement in pain and functional capacity between the initial evaluation and week 4, and the initial evaluation and week 8 in both groups (p <0.05). In the quality of life evaluation, the criteria for pain, functional capacity, and physical aspects had significant improvement after 8 weeks (p <0.05). There was no difference when comparing groups A and B (p >0,05). CONCLUSION Home-based exercise therapy, when performed in a period of eight weeks, using the booklet, was effective for improving level of pain, functional capacity, and quality of life in patients with non-specific chronic low back pain. The weekly supervision did not significantly influence the final outcome between the groups.

RESUMO OBJETIVO Avaliar dor, capacidade funcional e qualidade de vida de pacientes com dor lombar crônica inespecífica após terapia por exercícios domiciliares, com diferentes maneiras de supervisão. MÉTODO Trinta indivíduos de ambos os sexos, com idade entre 18 e 65 anos, apresentando dor lombar crônica inespecífica, realizaram os exercícios propostos três vezes por semana, durante oito semanas. Indivíduos do Grupo A (N=17) realizaram os exercícios após única sessão supervisionada. Já os indivíduos do Grupo B (N=13) foram supervisionados uma vez por semana no centro de reabilitação. Ambos receberam cartilha com orientações e questionários para avaliar dor, capacidade funcional e qualidade de vida; durante avaliação inicial, após quatro e oito semanas. RESULTADOS Houve melhora da dor e capacidade funcional entre as avaliações inicial e semana 4, e inicial e semana 8 nos dois grupos (p<0,05). Na avaliação de qualidade de vida (SF-36), os critérios de dor, capacidade funcional e aspectos físicos obtiveram melhora significativa após oito semanas (p<0,05). Não houve diferença significativa ao comparar os grupos (p>0,05). CONCLUSÃO A terapia por exercícios domiciliares, quando realizada num período de oito semanas, com auxílio da cartilha, foi eficaz para melhora da dor, capacidade funcional e qualidade de vida, em pacientes com dor lombar crônica inespecífica. A supervisão semanal não influenciou de forma significativa o resultado final quando comparados os grupos.

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RESUMO Os músculos da expiração têm funções em todo o ciclo respiratório, mas não são frequentemente avaliados no desmame da ventilação mecânica. Assim, revisões e consensos não mencionam a pressão expiratória máxima (PEmáx) e o treino expiratório. Objetivou-se investigar a relação da força muscular expiratória com a respiração espontânea de indivíduos ventilados mecanicamente. Trata-se de um estudo transversal com participantes de 18 a 79 anos de idade. Foram formados os grupos PEmáx satisfatória (GPES) e PEmáx baixa (GPEB) conforme o ponto de corte de 55cmH2O e comparados a parâmetros de desmame. O GPES (n=9) teve desempenho superior ao do GPEB (n=21) no índice de respiração rápida e superficial (IRRS) (40,6±17,6rpm/L e 75,3±44,1rpm/L, respectivamente; p=0,022) e na frequência respiratória (f) (19,1±6,2rpm e 26,1±9,4rpm; p=0,044). A prevalência de PEmáx satisfatória foi pequena, observada no tamanho dos grupos. Além disso, embora a PEmáx percentual do valor predito tenha sido menor no GPEB, como esperado (67,2±15,4% vs. 45,8±14,7%; p=0,001), a pressão inspiratória máxima percentual não diferiu significantemente (82,4±21,8% vs. 67,8±18,4%; p=0,077). A PEmáx se correlacionou moderadamente com o IRRS (r=-0,406; p=0,026) e com a f (r=-0,426; p=0,017). Conclui-se que a PEmáx≥55cmH2O esteve associada à melhores valores no IRRS e na f, e que a redução da força muscular expiratória foi mais prevalente e severa que a da força muscular inspiratória.

RESUMEN Los músculos de la espiración tienen funciones en todo el ciclo respiratorio, sin embargo, no son frecuentemente evaluados en el desmame de la ventilación mecánica. Así, revisiones y consensos no mencionan la tensión espiratoria máxima (PEmáx) y el entreno espiratorio. Se ha objetivado investigar la relación de la fuerza muscular espiratoria con la respiración espontánea de los individuos ventilados mecánicamente. Se trata de un estudio transversal con participantes de 18 a 79 años de edad. Han sido hechos los grupos PEmáx satisfactoria (GPES) y PEmáx baja (GPEB) de acuerdo con el punto de corte de 55cmH2O y han sido comparados a parámetros de destete. El GPES (n=9) ha tenido el desempeño superior al del GPEB (n=21) en el índice de respiración rápida y superficial (IRRS) (40,6±17,6rpm/L y 75,3±44,1rpm/L, respectivamente; p=0,022) y en la frecuencia respiratoria (f) (19,1±6,2rpm y 26,1±9,4rpm; p=0,044). La prevalencia de PEmáx satisfactoria ha sido pequeña, ha sido observada en el tamaño de los grupos. Además de eso, aunque la PEmáx porcentual del valor predicho haya sido menor en el GPEB, como ha sido esperado (67,2±15,4% vs. 45,8±14,7%; p=0,001), la presión inspiratoria máxima porcentual no ha diferido significantemente (82,4±21,8% vs. 67,8±18,4%; p=0,077). La PEmáx se ha correlacionado moderadamente con el IRRS (r=-0,406; p=0,026) y con la f (r=-0,426; p=0,017). Se concluye que la PEmáx≥55cmH2O ha estado asociada a los mejores valores en el IRRS y en la f, y que la reducción de la fuerza muscular espiratoria ha sido más prevalente y severa que la de la fuerza muscular inspiratoria.

ABSTRACT The expiratory muscles have functions throughout the respiratory cycle, but they are not often evaluated in the weaning from mechanical ventilation. Thus, reviews and consensus do not mention the maximal expiratory pressure (MEP) and the expiratory training. The aim of this study was to investigate the relationship of expiratory muscle strength with the spontaneous breathing of individuals on mechanical ventilation. This is a cross-sectional study with participants aged between 18 and 79 years. The groups satisfactory MEP (SMEPG) and low MEP (LMEPG) were formed according to the cut-off point of 55 cmH2O and compared to weaning parameters. The SMEPG (n=9) had better performance than LMEPG (n=21) in the rapid shallow breathing index (RSBI) (40.6±17.6 bpm/L and 75.3±44.1 bpm/L, respectively; p=0.022) and in the respiratory rate (RR) (19.1±6.2 bpm and 26.1±9.4 bpm; p=0.044). Prevalence of satisfactory MEP was low, as observed in the size of groups. In addition, although the MEP percentage of the predicted value was lower in LMEPG, as expected (67.2±15.4% vs. 45.8±14.7%; p=0.001), the percentage for maximal inspiratory pressure was not significantly different (82.4±21.8% vs. 67.8±18.4%; p=0.077). The MEP was moderately correlated with the RSBI (r=−0.406; p=0.026) and with the RR (r=−0.426; p=0.017). It was concluded that MEP≥55 cmH2O was associated with better values in RSBI and RR and that the reduction of expiratory muscle strength was more prevalent and severe than that of inspiratory muscle strength.

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Introdução: a literatura aponta controvérsias sobre a estabilização proporcionada pela ativação antecipatória dos músculos profundos do tronco e as evidências baseadas na análise bilateral do tempo de reação (onset) muscular de sujeitos com dor lombar são escassas. Objetivos: comparar o onset muscular do tronco entre sujeitos saudáveis e com dor lombar recorrente, bem como, comparar o onset muscular entre os lados do tronco nestas populações. Métodos: 19 sujeitos com dor lombar e 19 sujeitos saudáveis executaram o teste de elevação do membro superior dominante, no qual foram coletados os sinais eletromiográficos dos músculos do tronco. Resultados: na comparação entre os grupos, sujeitos com dor lombar apresentaram respostas mais rápidas do oblíquo interno contralateral ao membro elevado (p= 0,016). Na comparação entre os lados, sujeitos saudáveis apresentaram diferença significativa entre o onset dos oblíquos internos (p= 0,043). Conclusão: a dor lombar recorrente provoca alteração das respostas motoras geradas pela perturbação postural.

Introduction: The literature showed controversies about the stabilization provided by the anticipatory activation of the deep trunk muscles and the evidence based on the bilateral analysis of the muscle reaction time (onset) of subjects with low back pain is poor. Objectives: to compare the trunk muscle onset between healthy subjects and people with recurrent low back pain, as well as to compare the onset between the trunk sides in these populations. Methods: 19 subjects with low back pain and 19 healthy subjects performed the arm elevation test of the dominant upper limb, in which the electromyographic signals of the trunk muscles were collected. Results: in the groups comparison, subjects with low back pain had faster responses of the contralateral internal oblique to the raised limb (p = 0,016). In the comparison between the sides, healthy subjects presented significant difference between the onset of the internal oblique (p = 0,043). Conclusion: recurrent low back pain causes alteration of the motor responses generated by the postural destabilization.

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OBJECTIVE: The purpose of this study was to compare transcutaneous electrical nerve stimulation (TENS) and stabilization exercises in an attempt to prevent fatigue and improve muscle activation in patients with lumbar disk herniation associated with low back pain. METHODS: This study involved 29 patients (age range 25-58 years) randomized into 2 groups: the segmental stabilization group (n = 15), who received stabilization exercises on the transversus abdominis (TrA) and lumbar multifidus muscles; and the TENS group (n = 14), who received electrotherapy. Groups underwent 16 sessions, for 60 minutes, twice per week, and they were evaluated before and after intervention. Pain was measured using a visual analog scale, functional disability using the Oswestry Disability Index, muscle activation and fatigue with electromyography, and patients' ability to contract the TrA with a pressure biofeedback unit. Analyses within and between groups were performed. RESULTS: The stabilization group improved lumbar multifidus fatigue (median frequency [MF] initial [P = .002], MF final [P < .001], MF slope [P = .001], and resistance time [P < .001]), ability to contract the TrA (P < .001), pain (P < .001), and functional disability (P < .001). TENS only was effective for pain (P = .012). CONCLUSION: Although it relieved pain, TENS was not effective as a single treatment to prevent fatigue, increase TrA contraction, and reduce functional disability in herniated disk patients. Stabilization exercises alone improved all measured outcomes.

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