Muscle Imbalance Research Articles

Upper Crossed Syndrome and Scapulae Upper-Trapping: A Mesotherapy Protocol in Cervicoscapulobrachial Pain—The 8:1 Block

Upper Crossed Syndrome (UCS), described by Vladimir Janda, is characterized by postural changes involving the cervical spine and trunk, leading to biomechanical limitations and cervicoscapulobrachial pain. This study proposes a mesotherapy protocol, termed the 8:1 block, to address cervicoscapulobrachialgia by targeting the scapulae and associated musculature. The scapula, central to shoulder girdle kinematics, often exhibits dyskinesis and muscular imbalances, notably the pattern referred to as scapular upper trapping (SUT). SUT involves scapular elevation, medial rotation, and shoulder protraction, contributing to cervicobrachial pain. The protocol includes a comprehensive assessment of muscle tone changes and biomechanical considerations, highlighting the importance of the scapula in upper limb movement and posture. Key anatomical changes involve tightened upper trapezius, levator scapulae, and pectoralis minor muscles, with weakened middle trapezius and serratus anterior. The mesotherapy approach targets these imbalances through specific injection points to alleviate muscle tension and correct postural deviations. Case studies from our clinic demonstrate the protocol’s effectiveness in reducing pain and restoring scapular biomechanics. Patients reported significant improvements in pain relief and functional outcomes, underscoring the clinical utility of the 8:1 block in treating cervicoscapulobrachialgia. This protocol offers a feasible, cost-effective intervention that enhances the efficacy of traditional therapeutic exercises by addressing underlying muscular and biomechanical dysfunctions. In conclusion, the 8:1 block mesotherapy protocol provides a novel approach to managing cervicoscapulobrachial pain by focusing on scapular biomechanics and muscle tension. Further studies are needed to validate these findings and refine the protocol for broader clinical application.

Common sports‐related nerve injuries seen by the electrodiagnostic medical consultant

AbstractThe high physiologic demands of sports create dynamic stress on joints, soft tissues, and nerves which may lead to injuries in the athlete. Electrodiagnostic (EDx) assessment is essential to identify the correct diagnosis, localization, and prognosis, to guide management of sports‐related neuropathies. A comprehensive review was performed to provide the EDx medical consultant with a practical approach to the common peripheral nerve disorders seen in athletes. Sports‐related neuropathies reviewed include transient traumatic irritation of the brachial plexus and/or cervical nerve roots (“Burners and stingers,”) suprascapular and axillary neuropathies, ulnar neuropathy at the elbow (UNE) in throwers, ulnar neuropathy at the hand/wrist in cyclists, multi‐ligamentous knee injury, and foot/ankle neuropathies including tarsal tunnel syndrome. A thorough understanding of peripheral anatomy, possible entrapment sites, mechanisms of injury, and key physical examination findings is essential for correct diagnosis. EDx assessments beyond routine studies are generally required for sports‐related neuropathy, which may not necessarily follow typical entrapment patterns. Adjunct diagnostic imaging, such as point‐of‐care ultrasound and magnetic resonance imaging, are helpful tools to identify associated musculoskeletal pathology such as compressive cysts or nerve entrapment, which may be amenable to interventional or surgical treatment. When no clear reversible structural pathology exists, management of sports‐related neuropathy is athlete‐specific and generally multi‐modal, involving a combination of physical rehabilitation techniques to address muscle imbalances, load management, protective equipment, and interventional pain procedures.

Hamstring-to-Quadriceps Strength Ratios in Women Team Sport Athletes: A Systematic Review

ABSTRACT Women experience a higher rate of anterior cruciate ligament (ACL) injuries than men. Muscle imbalance, in particular hamstring-to-quadriceps (H:Q) strength ratio, is considered a risk factor for ACL injury. The purpose of this systematic review was to identify isokinetic H:Q strength ratios in women team sport athletes and determine whether cutoff values, determined from research with predominantly males, of >0.6 for conventional ratio (Hamstringconcentric:Quadricepsconcentric [CR]) and >1.0 for functional ratio (Hamstringeccentric:Quadricepsconcentric [FR]) were met. The CR (0.6) was not met for team ([mean ± SD: 0.56 ± 0.08]), field (0.57 ± 0.08), and court (0.56 ± 0.08) sports. Handball presented the highest (0.58 ± 0.07), and softball presented the lowest CRs (0.47 ± 0.06). The FR (1.0) was not met for team (0.69 ± 0.14), field (0.85 ± 0.14), and court (0.65 ± 0.14) sports. Soccer presented the highest (0.85 ± 0.14) and handball the lowest (0.66 ± 0.13) FRs. When assessing hamstring and quadriceps strength balance, women team sport athletes did not meet CR or FR values, which may contribute to increased ACL injury risk. H:Q ratios below cutoff values may indicate compromised hamstring strength. It is recommended practitioners implement strength exercises aimed to improve H:Q ratios.

Lower cross syndrome: specific treatment protocol versus generalized treatment protocol. A randomized single-blinded trial.

Lower crossed syndrome (LCS) is a biomechanical muscle imbalance causing low back pain.

Comparative Efficacy of Quadratus Lumborum Muscle Energy Technique with Gluteus Medius Strengthening Versus Gluteus Medius Strengthening Alone in Sacroiliac Joint Dysfunction: A Randomized Controlled Trial

Background: Pain in the sacroiliac joint is the most prevalent and often overlooked. The sacroiliac joints are thought to be sources of pain in roughly 10% to 25% of patients with chronic lower back pain. Due to the biomechanical nature of the joint, muscle imbalance is the most important cause of sacroiliac joint dysfunction. The hamstring and gluteus medius are the primary muscles involved in postural dysfunction-related muscle imbalance; however, the quadratus lumborum’s role in the compensatory mechanism is becoming more apparent, and its potential for treatment in conjunction with gluteus medius strengthening has not yet been investigated. Gluteus medius exercises, along with conventional treatment, are routinely given to patients with sacroiliac joint dysfunction; however, the aim of this study is to explore the additional effects of the muscle energy technique (MET) on the quadratus lumborum along with strengthening of the gluteus medius on pain, disability and quality of life of patients with sacroiliac joint dysfunction. Methods: Using a computer-generated random number table, seventy patients with unilateral sacroiliac joint pain were divided equally and randomly into two groups. Prior to initiating treatment, baseline measurements were taken using a hand-held dynamometer, visual analog scale (VAS), Oswestry Disability Index (ODI-U) and short form 36-item survey (SF-36v2) to assess strength, pain, functional disability and quality of life, respectively. Over the course of four weeks, all patients received twelve sessions, and both the pre- and post-intervention outcome measures were documented. Results: After 4 weeks of treatment, both groups showed statistically significant (p < 0.005) mean improvements in muscle strength, pain, disability and quality of life before and after intervention. However, the mean improvements in post-intervention on a dynamometer, VAS, ODI and SF-36 were better in the MET with exercise group (METGME) as compared to the conventional group with exercise (CTGME), with a larger effect size. Conclusions: The muscle energy technique, applied to the quadratus lumborum in combination with gluteus medius strengthening, is more effective clinically and significantly in improving pain, disability and quality of life in comparison to conventional treatment of sacroiliac joints with gluteus medius exercises.

Investigation of the playing digital games on shoulder flexibility, muscle strength and reaction speed in volleyball players

Esports is a natural extension of digital games. Digital games provide a platform for players to showcase their skills, thereby forming the foundation of e-sports. These two domains continuously support each other, demonstrating significant growth in popularity and establishing a solid presence in the competitive landscape. Digital games require high levels of attention, strategy, reflexes, and coordination, offering pathways to reach the pinnacle of competition. The benefits derived from digital games enhance the ability to perform effectively under stress, making them crucial for both physical and mental performance. This study investigates the effects of digital gaming on the physical performance, shoulder flexibility, muscle strength and reaction speed of female volleyball players. A total of 50 female volleyball players took part, who were divided into two groups based on their digital playing habits: Group 1 consisted of female players who played video games for at least 4 h per day in the last 6 months, while Group 2 included those who played <4 h per day. In the study, the Activ5© Handheld Digital Dynamometer was used to measure the strength of the shoulder muscles during various movements, including flexion, hyperextension, abduction, internal rotation and external rotation. In addition, the BlazePod™ trainer device was used to assess reaction times. The results showed that volleyball players who frequently played digitally showed significant improvements in shoulder flexibility, especially in flexion of the non-dominant side. In addition, these players showed faster reaction times than those who played less frequently. However, a significant decrease in hyperextension muscle strength was observed in the group that frequently played digital games. The study highlights that while digital games can improve certain physical skills such as reaction speed and shoulder flexibility, they can also contribute to muscular imbalances or a decrease in muscle strength in certain areas. These findings suggest potential benefits for volleyball players, particularly in movements that require quick reflexes and flexibility, such as serving and spiking. However, the results also raise concerns about potential negative effects on muscle strength and posture, highlighting the need for balanced training programs to mitigate these effects. Further research is needed to investigate the long-term effects of digital games on athletic performance and physical health.

EFFECTIVE REHABILITATION STRATEGIES FOR MUSCLE INJURIES IN FOOTBALL PLAYERS

The rehabilitation of muscle injuries in football players is a pivotal area of sports physiotherapy, addressing the intense physical demands and high injury rates associated with the sport. Muscle injuries often arise from factors such as overload, muscle imbalances, and improper techniques, impacting athletes' performance and career longevity. To optimize recovery, evidence-based methodologies are crucial, allowing physiotherapists to create personalized rehabilitation programs tailored to the specifics of each injury. Central to effective rehabilitation is a thorough functional assessment, which identifies specific deficits in players. Techniques such as electrotherapy and therapeutic ultrasound are effective in accelerating healing and reducing pain, while functional taping provides support without restricting movement. Neuromuscular rehabilitation is equally vital, incorporating proprioceptive exercises to enhance stability and prevent future injuries. The multidisciplinary approach, involving collaboration between physiotherapists, medical professionals, nutritionists, and coaches, ensures comprehensive care for athletes. Psychological support also plays a key role in addressing anxiety and fostering a positive mindset during recovery. Recent studies underscore the importance of accurate diagnosis and individualized treatment plans, utilizing frameworks like the PRICE principle and specific rehabilitation protocols that facilitate faster and safer returns to play. The literature indicates a gap in understanding among team managers regarding the role of sports physiotherapy, highlighting the pressure players face to return prematurely, which increases the risk of re-injury. In summary, successful rehabilitation of muscle injuries in football necessitates a comprehensive, personalized approach that integrates physical, nutritional, and psychological elements. As research continues to evolve, these strategies will enhance the effectiveness of rehabilitation programs, ensuring football players can recover fully and maintain optimal performance levels.

COMPREHENSIVE INJURY PREVENTION STRATEGIES FOR FOOTBALL PLAYERS

Injury prevention in football is a critical issue for athletes, coaches, and health professionals, given the sport's dynamic movements that elevate the risk of muscle and joint injuries. Effective strategies should incorporate specialized physical training and physiotherapeutic interventions to optimize player protection and performance. Preventive training programs, emphasizing muscle strengthening and proprioception, are essential for reducing injury risks. Specific exercises targeting the hamstrings, quadriceps, calves, and core enhance joint stability and mitigate overload injuries. Neuromuscular training, which includes balance exercises and plyometrics, improves proprioception and helps prevent falls and twists. Flexibility through regular stretching and dynamic warm-ups, such as the FIFA 11+, is crucial for preparing players physically and lowering injury incidence. Additionally, physiotherapists play a vital role in injury prevention through functional assessments to identify muscle imbalances and develop corrective exercise programs. Manual therapy techniques, joint stabilization exercises, and preventive rehabilitation further contribute to maintaining soft tissue quality and preventing muscle strains. Monitoring training load is another fundamental aspect of injury prevention, as abrupt changes in training intensity can lead to injuries. Using tracking technologies allows for better control of players' physical efforts. Studies indicate that implementing structured injury prevention programs significantly reduces injury rates and enhances athletic performance. Research highlights the importance of a multicomponent approach, individualized training, and load management to lower hamstring injuries. Collaboration among athletes, coaches, and health professionals is crucial to create a safe training environment. As football evolves, prioritizing injury prevention is essential for players' health, success, and career longevity.

An observational study of lower limb muscle imbalance assessment and gait analysis of badminton players

PurposeThe imbalance of muscle strength indicators has a negative impact on players. Lower limb muscle imbalance can cause gait abnormalities and increase the risk of muscle injury or decreased performance in significantly asymmetrical situations. This study aims to assess the lower limb muscle imbalance and gait feature between the dominant and non-dominant sides of badminton players and the associations between the two variables.MethodsThe study included 15 badminton players with years of training experience. Muscle strength and gait parameters were obtained from isokinetic muscle strength testing and plantar pressure analysis systems. The symmetry index was calculated based on formulas such as plantar pressure distribution and percentage of plantar contact area.ResultsIn the isokinetic muscle strength test, significant differences were found in bilateral knee flexors’ average power and total work at 60°/s angular speed. The hamstring to quadriceps ratio (H/Q) range of knee joints of the dominant and non-dominant sides is 0.63–0.74 at low speed, while the H/Q range is 0.81–0.88 at fast speed. The H/Q of bilateral knees increases with increasing angular velocity. As the angular velocity increases, the peak torque to body weight ratio (PT/BW) of the participants’ bilateral knee flexors and extensors shows a decreasing trend. The asymmetry score of H/Q at 180°/s angular speed is positively related with step time and stance time. There are varying degrees of differences in gait staging parameters, plantar pressure in each area, plantar contact area, and symmetry index between the dominant and non-dominant sides of badminton players when walking.ConclusionBadminton players have weaker flexors of the knee joint, imbalanced muscle strength in flexors and extensors, decreased lower limb stability, and a risk of knee joint injury on the non-dominant side. The bending and stretching strength of the knee joint on the dominant side of the players is greater than that on the non-dominant side. The pressure in the first metatarsal region of the dominant side is higher, while that in the midfoot and heel regions is higher on the non-dominant side. badminton players have better forward foot force and heel cushioning ability. Long term badminton sports result in specialized changes in plantar pressure distribution and reduced symmetry.

The effect of tongue-to-palate on deep neck flexor activity

Deep neck flexor (DNF) muscles contribute to cervical stability and proprioception. Reduced muscle strength and endurance lead to faulty movement patterns, muscle imbalances, and dysfunction. Potentially, the orofacial muscles contribute to cervical strength by providing stability through muscular connections. This study examined effects of tongue muscle activity on cervical spine muscular stiffness. Twenty-three healthy subjects assumed three supine positions [at rest (AR), chin tuck (CT), and head lift (HL)] with and without tongue-to-palate pressure. The DNF stiffness was measured using shear wave elastography. Without tongue-to-palate, stiffness increased with CT and HL compared to AR (p <0.001) but not between CT and HL (p = 0.22). Tongue-to-palate increased stiffness AR (p <0.001) but not during CT (p = 0.95) or HL (p = 0.67). Stiffness levels between the AR and HL conditions during tongue-to-palate performance did not differ (p = 0.734), but CT stiffness was significantly greater than AR (p = 0.029) with tongue-to-palate. Tongue-to-palate AR increases DNF stiffness to a similar level as HL with or without tongue-to-palate, while CT with or without tongue-to-palate resulted in the highest stiffness levels. Tongue-to-palate pressure AR or with CT performance may be alternatives to HL strengthening in healthy necks. This may be a useful strategy to increase cervical stability during loads on the cervical spine.

Comparing the effectiveness of Muscle energy technique, positional release technique and conventional therapy on pain,range of motion and functional ability in patients with mechanical low back pain

BACKGROUND OF THE STUDY:Low back pain is one of the most common health problem and 80 percent of the people experiences low back pain in their lifetime. Majority of low back pain is due to the muscle imbalance. Muscle imbalance occurs due to shortened or lengthened in structure and it leads to injury which causes changes in motor programming. OBJECTIVE: To compare the effects of Muscl Energy Technique, positional release technique and conventional therapy on improving pain, range of motion and functional ability in patients with mechanical low back pain. SUBJECTS AND METHODS:Twenty four patients of complaining of mechanical low back pain participated in the study. Patients were randomly allocated using computer generator software into three groups: group A which recieved Muscle energy technique, group B which recieved Positional release technique and group C which recieved conventional therapy. Treatment sessions were given three times per week for three weeks. Patients were assessed before and after treatment using Numerical Pain Rating Scale(NPRS), Modified Oswestry Disability Index(MODI), and Modified Schober's Test to assess pain severity, functional ability and range of motion of lumbar spine respectively. RESULTS: Based on this statistical analysis, Group A showed better Statistical significance in NPRS, MODI and ROM mean value as compared to Group B and C. Hence alternate hypothesis is accepted and null hypothesis is rejected. This we conclude that Muscle energy technique is more beneficial compared to Positional release technique and conventional therapy. Conclusion: Muscle energy technique and conventional therapy groups shows significant improvement on pain and lumbar extension range of motion compared to Positional release technique, whereas there was no significant difference in MODI on muscle energy technique, positional release technique and conventional therapy

Effects of Fatigue on Ankle Flexor Activity and Ground Reaction Forces in Elite Table Tennis Players.

Fatigue specifically affects the force production capacity of the working muscle, leading to a decline in athletes' performance. This study investigated the impact of fatigue on ankle flexor muscle activity and ground reaction forces (GRFs) in elite table tennis players, with a focus on the implications for performance and injury risk. Twelve elite male table tennis athletes participated in this study, undergoing a fatigue protocol that simulated intense gameplay conditions. Muscle activity of the soleus (SOL) and gastrocnemius lateralis (GL) muscles, heel height, and GRFs were measured using a combination of wireless electromyography (EMG), motion capture, and force plate systems. Results showed a significant decrease in muscle activity in both legs post-fatigue, with a more pronounced decline in the right leg. This decrease in muscle activity negatively affected ankle joint flexibility, limiting heel lift-off. Interestingly, the maximal anteroposterior GRF generated by the left leg increased in the post-fatigue phase, suggesting the use of compensatory strategies to maintain balance and performance. These findings underscore the importance of managing fatigue, addressing muscle imbalances, and improving ankle flexibility and strength to optimize performance and reduce the risk of injuries.

Talocalcaneonavicular Realignment: The Foundation for Comprehensive Reconstruction of Severe, Resistant Neurologic Cavovarus, and Equinocavovarus Foot Deformities in Children and Adolescents.

The progression of neurologic cavovarus (NCV) and equinocavovarus (NECV) foot deformities during growth can eventually lead to non-reducible severe talonavicular (TN) and subtalar (ST) joint rotational malalignments. This study aimed to describe a technique to correct severe, resistant inversion deformity of the ST joint complex as the foundational procedure in comprehensive reconstruction of multi-segmental NCV and NECV deformities in pediatric patients and to analyze mid-term radiologic, functional, and satisfaction outcomes. This prospective study included children with severe NCV and NECV foot deformities who underwent TCNR between 2019 and 2022, with a minimum follow-up of 2 years. Talocalcaneal angle, talus-1 metatarsal angles, and TN coverage angle were measured in preoperative and postoperative weight-bearing foot radiographs. The foot and ankle disability index, foot function index, and Maryland foot score evaluated functionality. Qualitative questions assessed perceived improvement, satisfaction, and expectations of patients/caregivers. Descriptive, comparative pre-post, subgroup, correlation, and satisfaction analysis were performed. Twenty-six patients (36 feet: 16 unilateral and 10 bilateral) were included; 50% were female, median age was 12.1 years (IQR, 3.21) and median follow-up was 32.9 months (IQR, 18.7). Fifty-four percent had cerebral palsy, and 23% had charcot-marie-tooth disease; 84.6% were ambulatory. Significant improvements were found in radiologic parameters and functional outcomes (P<0.01), with no relevant differences between unilateral or bilateral procedures, pathology, functional level, or ambulatory capacity (P>0.05). Correlations between radiologic parameters or functional scales with age were generally low. Most reported significant functional improvements, outcomes exceeding expectations, and high satisfaction; they would recommend the surgery and undergo the procedure again. There were 3 minor complications: hypersensitivity, partial recurrence, and undercorrection. The TCNR technique enables realignment of severe, resistant inversion deformity of the ST joint complex in NCV and NECV foot deformities. When combined with procedures to correct the other foot deformities and muscle imbalances, functional outcomes are enhanced, high patient/caregiver satisfaction is achieved, and low complication rates are possible. This approach represents an important modification and extension of an already described technique, the deep plantar-medial release. Level III, therapeutic prospective cohort study.

Electromyographic comparison of exercises for scapulothoracic muscle activation in men with upper crossed syndrome: A cross-sectional study

ObjectiveThis study aimed to determine the optimal exercise for improving Upper Crossed Syndrome (UCS) using electromyographic (EMG) activity of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) during ten exercises. MethodA cross-sectional study involved 30 male students (mean age: 25.3 ± 2.5 years; height: 176.8 ± 7.2 cm; weight: 77.7 ± 2.5 kg; BMI: 23.8 ± 0.72 kg/m2) with UCS. Participants were selected based on postural assessments (forward head posture ≥44°, rounded shoulder ≥49°, thoracic kyphosis ≥42°). EMG was used to measure activation levels of UT, MT, LT, and SA, and the UT activation ratio relative to MT, LT, and SA during ten exercises. One-way ANOVA was applied for data analysis. ResultsSide-lying external rotation, standing diagonal flexion with Thera-band, and lying prone “V” demonstrated the least UT activity, with the highest MT and LT activation. The standing diagonal flexion with Thera-band elicited the highest SA activity. UT/MT, UT/LT, and UT/SA ratios were less than one in multiple exercises. Significant differences in muscle activation levels and ratios were observed across all exercises (P ≤ 0.05). ConclusionThe findings suggest significant clinical implications for UCS rehabilitation. The identified exercises effectively engage MT and LT while minimizing UT activation, addressing muscular imbalances. Favorable UT/MT, UT/LT, and UT/SA ratios further support these exercises in correcting UCS. These exercises may help counteract the underlying muscular imbalance in UCS by promoting a more balanced activity ratio among the shoulder girdle muscles, potentially improving posture and reducing UCS symptoms.

Prevalence of Upper Cross Syndrome Among Heavy Vehicle Drivers (HVD): A Cross-Sectional Study

Background: Heavy vehicle drivers (HVDs) are at risk for musculoskeletal disorders, including Upper Cross Syndrome (UCS), due to prolonged sitting and repetitive tasks. UCS is characterized by muscle imbalances in the neck, shoulders, and upper back, leading to pain and functional impairment.Objective: This study aimed to assess the prevalence of UCS among HVDs and identify contributing factors such as working hours and pain intensity.Methods: A cross-sectional study was conducted from March 2024 to August 2024, involving 212 male HVDs aged 25-55 years, working for over a year, and experiencing neck and back pain for more than three months. Exclusion criteria included recent spinal trauma or deformities. Data were collected using the Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI) and analyzed using SPSS version 25. Chi-square tests and linear regression were applied.Results: UCS was prevalent in 26.4% of drivers. A significant relationship was found between pain intensity and disability (χ² = 170.126, p = 0.000). Most drivers (66.9%) were aged 25-35 years, and 30.2% reported very mild pain.Conclusion: UCS is significantly prevalent among HVDs, with long working hours and poor ergonomics contributing to its onset.

Study of prevalence of non-strabismic binocular vision anomalies in a tertiary centre: An important but often forgotten cause of ophthalmic headache

To study the presence of non strabismic binocular vision anomalies in young patients presenting with headache. A prospective, non-interventional study of 110 patients was conducted for a period of one year in our tertiary eye care institute after obtaining informed consent and taking into consideration the inclusion and exclusion criteria. Patients presenting with asthenopic symptoms were subjected to thorough ophthalmic examination. After excluding refractive errors, patients were further subjected to detailed orthoptic evaluation (including accommodation and convergence assessment). Other non-ocular causes of headache were ruled out by appropriate referrals. Out of 110 patients, 33% were found to have accommodative insufficiency, 14% were having convergence insufficiency and 4% showed both accommodative and convergence insufficiency. 49% patients showed no extraocular muscle imbalance and were referred to relevant specialities for further evaluation. It is important to perform a thorough evaluation of patients presenting with headache for the presence of non strabismic binocular vision anomalies after ruling out other ophthalmic causes.

Hip Range of Motion and Strength in Young Pre-Professionals Ballet Dancers Versus Non-Dancers.

Introduction: Lower-extremity external rotation, commonly known as turnout, is a fundamental skill in dance. Limited data exist regarding joint range of motion and strength in pre-professional young dancers and non-dancers. This study aimed to evaluate the differences in hip range of motion and hip strength between pre-professional ballet dancers and non-dancers. Additionally, the study assessed the variations between the left and right sides within each group. Methods: This observational study assessed 60 pre-professional ballet dancers and 31 non-dancers with an average age of 11.91 ± 1.49. Evaluation included passive hip rotation, tibial torsion, total passive turnout measured with digital goniometers, and total active turnout (both static and dynamic) through standing on paper and rotational discs. Hip rotation strength was measured using a force sensor device. Statistical analyses encompassed student t-tests, Pearson's correlations, and ANCOVA with age and body weight as covariates, applying the Bonferroni correction for multiple comparisons. Results: Ballet dancers exhibited greater passive hip external rotation and lower passive hip internal rotation compared to non-dancers. They also demonstrated superior total active turnout (static and dynamic). After adjusting for age and weight, dancers demonstrated significantly higher hip external rotation strength than non-dancers. Hip internal rotation strength did not differ significantly between the groups. Ballet dancers displayed inherent asymmetry, with the left side showing greater tibial torsion and standing active turnout, while the right side exhibited greater hip external rotation during dynamic active turnout. Non-dancers did not show significant side differences. Conclusions: Young pre-professional ballet dancers exhibited significant hip rotation differences compared to non-dancers, including notable right-left asymmetry. These findings should be considered when planning training, aiming to optimize musculoskeletal attributes and promote balanced hip rotation. Recognizing these asymmetries and addressing muscular imbalances is vital for injury prevention and performance enhancement.

BENEFÍCIOS DO PILATES NA DOR LOMAR.

Low back pain, also called as lumbago, often causes functional disability. It is estimated that 80 to 84% of the world´s population will, suffer an episode of low back pain at some point in their lives. It can be related to pathologies such as infection, tumor, arthritis, fracture, cauda equina syndrome, disc herniation, and lifestyle factors; smoking, diet, sedentary lifestyle, and occupation; heavy physical work, repetitive movements. Pilates is an important treatment option for people with low back pain. Created by Joseph Humbertus Pilates, Pilates is a physical exercise method that makes it possible to condition the body and mind, correct muscle imbalances, improve posture, and tone the body. The objective of this work is to evaluate the effectiveness of the Pilates method in people with low back pain. This is a literature review based on the database pedro.org.au, which offers a specialized approach to physiotherapy research. The included studies cover, individuals aged 18 and over, ensuring the sample is composed of adults; all genders were considered in the study selection, ensuring representativity and inclusion of diverse populations.

Higher Unilateral Muscle Imbalance at the Contralateral Knee 6 Months after Anterior Cruciate Ligament Reconstruction.

There are a considerable number of patients who, after anterior cruciate ligament reconstruction (ACL), suffer from relapses or reduced performance. Data collected from isokinetic dynamometry can provide useful information on the condition of the knee during rehabilitation. Seventy-one young sports patients with ACL reconstruction performed concentric (CON) isokinetic dynamometry (CON/CON 90°/s and CON/CON 240°/s) to assess the muscle strength of the quadriceps (Q) and hamstrings (H) in both knees at 6 months after ACL reconstruction. Limb symmetry index (LSI) and the H/Q ratio were calculated. Comparative statistical tests and multivariate regression were performed. At 90°/s, 57 patients (80.3%) had an LSI below 90% for quadriceps and 28 (60.6%) for hamstring. The number of imbalanced patients according to H/Q ratio was higher in the non-operated knee (n = 56, 78.9%) (p < 0.001). At 240°/s, 49 cases (69.1%) had LSI values above 90% for quadriceps and 37 (52.1%) for hamstrings. Regarding H/Q, imbalanced cases were higher in the non-operated limb (n = 60, 84.5%) (p < 0.001). Strength data at 6 months after ACL reconstruction and post-operative rehabilitation indicated greater unilateral (H/Q) muscle imbalance in the non-operated knee than in the operated knee. Most patients did not achieve the adequate LSI values.

Three-dimensional evaluation of facial asymmetry and its association to occlusal and muscular imbalance in young women.

Diagnosing asymmetries and restoring functional balance are challenges in facial rehabilitation and aesthetic procedures. This cross-sectional observational study aimed to evaluate whether occlusal imbalance and the electromyographic activity of the masseter and temporalis muscles in young women may be associated with facial asymmetry. Fifty women (mean age ± standard deviation: 22.5 ± 2.7), without temporomandibular dysfunction and with balanced facial profiles, were divided into two groups categorized by receiver operating characteristic analysis: symmetric (n=25) and asymmetric (n=25). The variables included the evaluation of asymmetry through clinical examination, quantification of asymmetry using stereophotogrammetry through the root mean square method, asymmetry of occlusal contacts, and electromyographic activity of the masseter and temporal muscles in both latero-lateral and antero-posterior directions. The mean asymmetry indices were compared using Welch's t-test and the Mann-Whitney test. The impact of occlusal and muscular imbalance on facial asymmetry was assessed through linear regression analysis. A significant difference was observed between the groups in the asymmetry of occlusal contacts, with a considerable effect size (p<0.01 - Cohen's d=0.73). The imbalance in the electromyographic activities of the masseter and temporal muscles was considered a predictor of facial asymmetry (F=4.00, p<0.02, R²=0.15). Occlusal imbalance and electromyographic activity of the masseter and temporal muscles are associated with facial asymmetry. Key words:Facial asymmetry, masticatory muscles, stereophotogrammetry, occlusion, electromyography.