EM - ESSEM - Fisioterapia
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- Variability of ground reaction forces between lower limbs during running in male and female rugby players after hamstrings injury : a cross-sectional studyPublication . Marques, Nuno Miguel Toureiro; Oliveira, Paulo Ricardo Miranda; Fernandes, Orlando de Jesus Semedo MendesHamstring injuries are among the most common in rugby, frequently affecting athletic performance due to their influence on lower limb biomechanics. This cross-sectional observational study aimed to evaluate the temporal structure of ground reaction force (GRF) variability between injured and uninjured lower limbs in rugby players with a history of unilateral hamstring injury. Using Detrended Fluctuation Analysis (DFA), the study assessed the temporal structure of motor variability during treadmill running in a sample of 20 athletes (95% male). The DFA alpha values for injured limbs (M = 0.735) and uninjured limbs (M = 0.706) indicated persistent correlations within a functional range (0.5 < α < 1.0), with no statistically significant differences between limbs (p = 0.317). However, a slight trend toward increased motor rigidity in the injured limb was noted, potentially reflecting compensatory adaptations. DFA emerged as a sensitive tool capable of detecting subtle changes in motor control that may not be captured by conventional biomechanical analyses. Limitations included the small sample size, gender imbalance, and treadmill-only testing, which constrain generalizability. Nonetheless, the results highlight the potential of DFA as a valuable adjunct in return-to-play assessments and injury prevention protocols. Future research should adopt longitudinal designs and recruit more diverse samples valid settings to fully explore DFA diagnostic and rehabilitative applications in sports performance.
- Comparison of ground reaction force variability between sprint athletes with and without hamstring injury history : a cross-sectional studyPublication . Feliciano, Margarida Nobre; Oliveira, Paulo Ricardo Miranda; Fernandes, Orlando de Jesus Semedo MendesSprint running exposes the hamstring muscles to high mechanical loads, particularly during the late swing and early stance phases, which are recognized as critical periods of elevated injury risk for this muscle group. In sprinters with a history of hamstring injury (W/HHI), alterations in vertical ground reaction force (vGRF) variability may persist even after rehabilitation, reflecting potential neuromuscular adaptations or constraints. Determining whether this variability falls within a functional range is essential, as both excessive rigidity and instability can compromise performance and increase the risk of reinjury. In this cross-sectional study, 17 sprinters (7 W/HHI, 10 WO/HHI) performed a 60-second submaximal sprint on an instrumented treadmill. VGRF variability was assessed using Sample Entropy (SaEn) and analysis of the force–time relationship (log-log slope). The W/HHI group presented lower mean log-log slope values (0.175 ± 0.342; range from -0.417 to 0.627) compared to the WO/HHI group (0.497 ± 0.546; range from -0.137 to 1.875), although this difference did not reach statistical significance (p = 0.195). A tendency toward lower SaEn values was also observed in the W/HHI group (SaEn_Force: 1.80 ± 0.433 vs. 2.16 ± 0.402; p = 0.103; SaEn_Time: 2.26 ± 0.382 vs. 2.50 ± 0.337; p = 0.219), suggesting distinct motor control profiles. In the W/HHI group, greater variability in force did not compromise responsiveness, which may reflect compensatory motor reorganizations. By contrast, the WO/HHI group demonstrated greater robustness in the force–time relationship but also signs of force instability that appeared to be counterbalanced by temporal variability. These findings underscore the relevance of assessing the temporal structure of vGRF variability in sprinters, as it allows the identification of trends in motor adaptation and reorganization associated with injury history. Moreover, they highlight the importance of integrating neuromuscular re-education programs into physiotherapy and prevention protocols, with the aim of re-establishing functional variability specific to the demands of sprinting, thereby promoting a safe return to performance, optimizing performance and reducing reinjury risk.
- Comparison of acute cortical drive responses in scapular muscles after scapular-oriented exercises with electromyographic biofeedback or verbal and tactile feedback in healthy young adults : a randomized controlled trialPublication . Ferreira, João Francisco Santos; Neto, Carla MartinhoIntroduction: The scapular muscles are vital for movement and scapulohumeral rhythm. Electromyographic biofeedback and other feedback modalities are effective in enhancing electromyographic activity and motor control. Transcranial Magnetic Stimulation (TMS) assesses cortical plasticity, linking motor adaptations to the corticospinal system. A gap remains in the understanding of the role of cortical reorganization in mediating the effects of Electromyographic biofeedback on motor learning. This study compared the acute cortical drive responses in scapular muscles following exercises with Electromyographic biofeedback or verbal and tactile feedback in healthy young adults, hypothesizing greater responses with Electromyographic biofeedback. Methods: Twelve healthy young adults (aged 18–35) were recruited, all shoulder pain free and with no contraindications to TMS. Participants were randomized into two groups: TMS + Electromyographic biofeedback (BEMG) (n = 5) and TMS + Verbal/Tactile Feedback (AT) (n = 7). Both groups performed a single 30-minute exercise session focused on scapulothoracic muscles. Cortical drive was assessed via TMS, including Corticospinal Excitability (CSE), Silent Period (SP), and Short-Interval Intracortical Inhibition (SICI) of the Upper (UT) and Lower Trapezius (LT) muscles. Results: No significant differences were observed between groups in CSE or SP for either UT or LT. However, a statistically significant difference was found in the percentage change of UT SICI, with the AT group (verbal/tactile feedback) showing a substantially greater increase (mean difference = −64.89%; Cohen’s d = -1.325). For the LT, changes in SP showed a large effect size in favor of the AT group, although not statistically significant. Conclusion: Verbal and Tactile feedback may be effective strategies during the initial phases of scapulothoracic muscle strengthening, potentially facilitating motor learning more efficiently than visual feedback. The SICI results for the UT suggest distinct neuromodulator effects between feedback modalities. These findings should be interpreted with caution due to the small sample size (n = 12) and other methodological limitations. Future studies with larger samples and longer interventions are recommended.
- The association between muscle power and gait complexity in apparently healthy older adults : a correlational studyPublication . Ferreira, Filipa Cristina Luís; Vaz, João Pedro Casaca de RochaThis study explores the relationship between two established biomarkers of age-related functional decline: muscle power and gait complexity. Both are considered robust indicators of motor control decline, appearing before manifestations of age-related changes 1–4, but their interrelation remains unclear. We hypothesized a positive correlation between lower limb muscle power and gait complexity in healthy older adults. In this cross-sectional study, 28 participants aged 60 and above were analysed. Muscle power was assessed through a sit-to-stand task using a Bertec force plate, while gait complexity was measured during a 12-minute treadmill walk with a Bertec treadmill and custom MATLAB code. Correlation analyses showed no significant associations between muscle power (PRF/BW, RFD30/w, RFD100/w) and gait complexity (fractal scaling exponent α, or CV), with all coefficients low and p-values > 0.05. These findings suggest that, although both are early indicators of neuromuscular decline, muscle power and gait complexity may reflect distinct motor control mechanisms. Nevertheless, both remain valuable and complementary markers of functional aging.
- Comparison of cortical drive and muscle power in older adults with and without fear of falling : a comparative cross-sectional studyPublication . Sousa, Laís Karielly Rodrigues de; Radaelli, RégisIntroduction: Fear of falling (FoF) is a psychological factor that contributes to physical inactivity, social withdrawal, and increased fall risk. Previous evidence suggests age-related changes in cortical drive and muscle power. However, there is a lack of knowledge on how these changes affect FoF. This study aimed to compare corticospinal excitability (CSE), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), silent period (SP) and lower-limb muscle power between older adults with and without FoF. Methods: Eighteen communitydwelling older adults (g65 years old) participated and were classified into two groups based on the Falls Efficacy Scale International (FES-I): NFoF (score <28; n=10) and FoF (score g28; n=8). Cortical drive was assessed using Transcranial Magnetic Stimulation (TMS), with measures of active motor threshold (AMT), CSE, SICI, ICF. Lower-limb muscle power was measured via countermovement jump on a force platform. Physical activity levels were evaluated using the IPAQ-short form. Results: Groups were similar in age, BMI, and height. Participants with FoF had significantly more falls in the past 12 months (p=0.006). No statistically significant differences were found between groups for AMT (p=0.864), CSE (p=0.565), ICF (p=0.999), SICI (p=0.355) or SP (p=0.667). Physical activity levels did not differ significantly between older adults with and without FoF (p=0.342; §= 0.325). No statistically significant differences were found in absolute or relative muscle power between groups (p=0.141; d=0.735 and p=0.150; d=0.717, respectively). Conclusion: The FoF does not appear to influence neurophysiological parameters or lower-limb muscle power in this sample of older adults.
- Gait variability in anterior cruciate ligament injured athletes compared to healthy controlsPublication . Pinto, Ana Costa; Vaz, João Pedro Casaca de RochaBackground: Anterior cruciate ligament (ACL) injuries affect gait variability, motor control, and adaptability. This study examines stride-to-stride gait fluctuations in athletes with and without ACL injuries, focusing on variability as a marker of adaptability. Methods: A cross-sectional study was conducted with 15 ACL-deficient athletes and 12 healthy controls. Participants performed a 12-minute split-belt treadmill walking task, and gait variability was analyzed using Detrended Fluctuation Analysis (α-ISIs). Results: ACL-deficient athletes showed significantly lower α-ISIs values (0.78 ± 0.08) than healthy controls (0.85 ± 0.084, p = 0.045), indicating reduced gait complexity. No significant differences were found in the coefficient of variation (CV), and kinesiophobia showed a weak correlation with gait variability. Conclusions: This study demonstrated that individuals with ACL deficiency exhibit reduced gait complexity, characterized by increased randomness in variability patterns. The findings suggest that ACL deficiency impairs neuromuscular regulation, leading to compensatory gait adaptations. Despite stable variability magnitude, its temporal organization was significantly altered. These results emphasize the importance of gait complexity as a key marker for motor adaptability in ACL-deficient individuals.
- Comparison of external load variability in injured and uninjured youth elite football male athletes : a cross-sectional studyPublication . Passos, Fábio Gonçalo Sales; Vaz, João Pedro Casaca de RochaFootball's nature carries a high risk of injury, particularly given the increased amount of hard running and sprinting. This study aims to investigate the external load temporal structure between non-injured and injured football athletes, during a 10-day period prior to the injury event. A sample of 38 male youth elite football players was selected for the study. Information on their external load was gathered throughout a range of durations, and GPS data was used to gauge it. The results from linear GPS variables mean and standard deviation between the two groups weren’t statistically significant. On the other hand, the values from non-linear metrics, such as Detrended Fluctuations Analysis, showed that the alpha from the injured players was significantly lower (0.84±0.03) compared to non-injured players (0.86±0.03, p<0.05). We have observed greater randomness in the temporal structure of injured athletes. This study concludes that integrating these metrics may make GPS technology an even more effective tool for injury prevention and possible daily monitoring. Further research could include combined nonlinear measures with subjective fatigue measures to give a holistic picture of an athlete's condition with a larger sample size and other sports contexts
- Efeitos de um programa de terapia manual e exercícios terapêutico associados a um programa de exercício aeróbio de 6 semanas na disfunção temporomandibular muscularPublication . Fresco, Ana Catarina Dourado; Alves, Paula MoleirinhoIntrodução: A disfunção temporomandibular (DTM) é uma condição que pode afetar os músculos mastigatórios e conduzir ao aparecimento de dor e à diminuição da qualidade de vida. O objetivo deste estudo é a comparação dos efeitos de um programa de terapia manual e exercícios terapêuticos com um programa de terapia manual e exercícios terapêutico associado a exercício aeróbio de 6 semanas, na intensidade da dor, na amplitude de abertura oral, no limiar de tolerância de dor à pressão, na ansiedade e na qualidade de vida da saúde oral em sujeitos com DTM muscular. Metodologia: Ensaio clínico controlado, com 18 participantes diagnosticados através do Diagnostic Criteria for Temporomandibular Disorders (DC-TMD) com DTM muscular e divididos em dois grupos: G1 (26,8±7,92) com 11 participantes que realizou um programa de terapia manual e exercícios terapêuticos (uma vez por semana durante 30 minutos) e G2 (26,9±6,62) , com 7 participantes que realizou o mesmo programa de G1 (uma vez por semana durante 30 minutos) associado a exercício aeróbio de intensidade moderada (duas vezes por semana durante 30 minutos). Foi avaliada a intensidade da dor através da escala numérica da dor (NPRS), o limiar de tolerância de dor à pressão (PPT) através do algómetro, a amplitude de abertura oral máxima confortável (AMC) e forçada (AMF) através do paquímetro, a ansiedade através da Generalized Anxiety Disorder (GAD-7) e qualidade de vida relacionada com a saúde oral (QdRVSO) através da Oral Health Impact Profile (OHIP-14). O primeiro momento de avaliação (T1) foi realizado antes de se iniciar a intervenção e o segundo momento de avaliação (T2) 48h após o término do programa de 6 semanas. Resultados: Houve uma diminuição significativa da NPRS, um aumento significativo da AMC, AMF e da OHIP-14 em G1 e G2 entre T1 e T2. No PPT verificou-se um aumento significativo no masséter direito (MD) e temporal esquerdo (TE) no G1 e G2, e no masséter esquerdo (ME) e temporal direito (TD) apenas no G2. G1 e G2 apresentaram diferenças significativas no aumento do PPT, com o G2 a obter melhores resultados. Não se verificaram diferenças significativas na GAD-7. Conclusão: O programa de terapia manual e exercícios terapêuticos e o programa de terapia manual e exercícios terapêutico associado a exercício aeróbio conduziram a uma diminuição da dor, aumento de amplitude oral e melhoria da qualidade de vida ao fim de 6 semanas de intervenção. O programa de terapia manual e exercícios terapêutico associado a exercício aeróbio promoveu um maior aumento do limiar de tolerância de dor à pressão.
- The effects of different temporally structured cues on gait variability in anterior cruciate ligament injured athletesPublication . Hilário, Mafalda Sofia Pereira; Vaz, João Pedro Casaca de RochaThe anterior cruciate ligament (ACL) is essential for knee stability and proprioception. ACL injuries, often caused by non-contact valgus and internal rotation motions, lead to increased instability, altered joint pressures, and a higher risk of secondary injuries and osteoarthritis, causing a significant impact in the athlete’s career. Full restoration of neuromuscular function and gait variability remains unachieved. The purpose of this study is to investigate how different temporally structured cues affect gait patterns of acute ACL-injured athletes. Seventeen adult athletes with acute ACL-injury, were engaged in two 12-minute walking trials – one uncued trial and one cued trial – on a split-belt treadmill, at their optimal walking speed, previously calculated. A 10-minute resting period between trials. Additionally, the participants had to answer the Tampa Scale questionnaire. Inter-stride intervals were determined from a custom MATLAB code and fractal scaling obtained, through Detrended Fluctuation Analysis, was calculated. A mixed-model repeated measures ANOVA was used to identify differences between groups and conditions. The results showed that ACL-injured athletes from fractal group did not exhibit significant improvements in their temporal structure of gait patterns while walking to these cues, however isochronous group worsened it, towards to randomness, highlighting the potential clinical value of fractal cues.
- Efeito de um programa multimodal versus goteira oclusaL de 6 semanas na dor, abertura oral e qualidade de vida em adultos com disfunção temporomandibular (DTM) : um ensaio clínico controladoPublication . Mestre, Ana Marta Guerreiro; Alves, Paula MoleirinhoA disfunção temporomandibular (DTM) é uma condição de etiologia multifatorial que acomete a articulação temporomandibular (ATM), os músculos mastigatórios e estruturas associadas, impactando negativamente na qualidade de vida dos pacientes. Este estudo teve como objetivo avaliar e comparar o efeito de um programa multimodal (terapia manual combinada com exercícios terapêuticos) versus goteira oclusal, na modulação da dor, abertura oral e qualidade de vida de saúde oral (QdVRSO) no tratamento de adultos com DTM muscular com limitação da abertura oral durante 6 semanas. O ensaio clínico controlado incluiu 24 participantes com idades compreendidas entre os 18 e 50 anos, divididos em dois grupos experimentais: G1 (realizou um programa multimodal, uma vez por semana durante 30 minutos) e G2 (utilizou goteira oclusal diariamente, durante a noite). Os participantes foram avaliados em dois momentos, inicial e final, quanto à intensidade da dor, amplitude de abertura oral, limiar de tolerância de dor à pressão (PPT) e QdVRSO. Os resultados demonstraram que ambos os grupos obtiveram melhorias significativas na intensidade da dor, amplitude de abertura oral e QdVRSO, destacando a eficácia dessas abordagens conservadoras. O programa multimodal demonstrou superioridade no aumento da amplitude de abertura oral e na melhoria do PPT, enquanto a goteira oclusal apresentou maior eficácia na diminuição da intensidade da dor. A única diferença estatisticamente significativa entre os grupos foi observada no PPT, com melhorias significativas apenas no G1, o que pode indicar que o programa teve um maior contributo para a ativação das vias inibitórias descendentes de modulação da dor. Porém, os resultados demonstram que ambas as intervenções são válidas no tratamento de pacientes com DTM.