ABSTRACT BACKGROUND: Non-specific low back pain is a major health problem worldwide. Interventions based on exercises have been the most commonly used treatments for patients with this condition. Over the past few years, the Pilates method has been one of the most popular exercise programmes used in clinical practice. OBJECTIVES: To determine the effects of the Pilates method for patients with non-specific acute, subacute or chronic low back pain. METHODS: Search methods: We conducted the searches in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus from the date of their inception to March 2014. We updated the search in June 2015 but these results have not yet been incorporated. We also searched the reference lists of eligible papers as well as six trial registry websites. We placed no limitations on language or date of publication. Selection criteria: We only included randomized controlled trials that examined the effectiveness of Pilates intervention in adults with acute, subacute or chronic non-specific low back pain. The primary outcomes considered were pain, disability, global impression of recovery and quality of life. Data collection and analysis: Two independent raters performed the assessment of risk of bias in the included studies using the 'Risk of bias' assessment tool recommended by The Cochrane Collaboration. We also assessed clinical relevance by scoring five questions related to this domain as 'yes', 'no' or 'unclear'. We evaluated the overall quality of evidence using the GRADE approach and for effect sizes we used three levels: small (mean difference (MD) < 10% of the scale), medium (MD 10% to 20% of the scale) or large (MD > 20% of the scale). We converted outcome measures to a common 0 to 100 scale when different scales were used MAIN RESULTS: The search retrieved 126 trials; 10 fulfilled the inclusion criteria and we included them in the review (a total sample of 510 participants). Seven studies were considered to have low risk of bias, and three were considered as high risk of bias. A total of six trials compared Pilates to minimal intervention. There is low quality evidence that Pilates reduces pain compared with minimal intervention, with a medium effect size at short-term follow-up (less than three months after randomization) (MD -14.05, 95% confidence interval (CI) -18.91 to -9.19). For intermediate-term follow-up (at least three months but less than 12 months after randomization), two trials provided moderate quality evidence that Pilates reduces pain compared to minimal intervention, with a medium effect size (MD -10.54, 95% CI -18.46 to -2.62). Based on five trials, there is low quality evidence that Pilates improves disability compared with minimal intervention, with a small effect size at short-term follow-up (MD -7.95, 95% CI -13.23 to -2.67), and moderate quality evidence for an intermediate-term effect with a medium effect size (MD -11.17, 95% CI -18.41 to -3.92). Based on one trial and low quality evidence, a significant short-term effect with a small effect size was reported for function (MD 1.10, 95% CI 0.23 to 1.97) and global impression of recovery (MD 1.50, 95% CI 0.70 to 2.30), but not at intermediate-term follow-up for either outcome. Four trials compared Pilates to other exercises. For the outcome pain, we presented the results as a narrative synthesis due to the high level of heterogeneity. At short-term follow-up, based on low quality evidence, two trials demonstrated a significant effect in favour of Pilates and one trial did not find a significant difference. At intermediate-term follow-up, based on low quality evidence, one trial reported a significant effect in favour of Pilates, and one trial reported a non-significant difference for this comparison. For disability, there is moderate quality evidence that there is no significant difference between Pilates and other exercise either in the short term (MD -3.29, 95% CI -6.82 to 0.24) or in the intermediate term (MD -0.91, 95% CI -5.02 to 3.20) based on two studies for each comparison. Based on low quality evidence and one trial, there was no significant difference in function between Pilates and other exercises at short-term follow-up (MD 0.10, 95% CI -2.44 to 2.64), but there was a significant effect in favour of other exercises for intermediate-term function, with a small effect size (MD -3.60, 95% CI -7.00 to -0.20). Global impression of recovery was not assessed in this comparison and none of the trials included quality of life outcomes. Two trials assessed adverse events in this review, one did not find any adverse events, and another reported minor events. AUTHORS CONCLUSIONS: We did not find any high quality evidence for any of the treatment comparisons, outcomes or follow-up periods investigated. However, there is low to moderate quality evidence that Pilates is more effective than minimal intervention for pain and disability. When Pilates was compared with other exercises we found a small effect for function at intermediate-term follow-up. Thus, while there is some evidence for the effectiveness of Pilates for low back pain, there is no conclusive evidence that it is superior to other forms of exercises. The decision to use Pilates for low back pain may be based on the patient's or care provider's preferences, and costs.

Resumo O objetivo deste estudo foi verificar se o desequilíbrio dos músculos do joelho pode estar associado com o surgimento de lesões em corredores. Vinte corredores fizeram uma avaliação isocinética nas velocidades de 60, 180 e 300o/s e foram acompanhados por três meses para verificar a ocorrência de lesões. Quatro atletas (21%) apresentaram lesões que envolveram a região do joelho e o desequilíbrio muscular encontrado foi associado ao surgimento de lesões, nas três velocidades testadas (p < 0,05).

Abstract The aim of this study was to determine whether a muscle imbalance of the knee is associated with running injuries. Twenty runners were evaluated by an isokinetic dynamometer at 60, 180 and 300 degrees/second. Runners were followed for three months to determine the incidence of injuries. We used the chi-square test to verify the association between muscular imbalance and the appearance of injury. Four athletes experienced injuries (21%), all registered in the knee. Muscle imbalance was associated with running-related injuries for the three tested velocities (p < 0.05). To conclude, a muscle imbalance may be associated with running injuries.

Resumen El objetivo de este estudio fue determinar si el desequilibrio muscular de los músculos de la rodilla puede estar asociado con la aparición de lesiones en corredores. Veinte corredores realizaron una evaluación isocinética a velocidades de 60, 180 y 300º/s. Se hizo un seguimiento de los participantes durante tres meses para determinar la incidencia de las lesiones. Se utilizó la prueba de chi cuadrado para determinar la asociación entre la aparición de un desequilibrio muscular y la de las lesiones. Cuatro atletas (21%) presentaron lesiones en la región de la rodilla. El desequilibrio muscular se asoció con la aparición de lesiones en las tres velocidades probadas (p < 0,05). Se concluyó que un desequilibrio muscular puede estar asociado con la aparición de lesiones en corredores.

O presente estudo teve como objetivo verificar a prevalência de dor de origem musculoesquelética em praticantes de caminhada e os possíveis fatores associados. Trata-se de um estudo transversal, realizado por meio de um formulário aplicado aos praticantes de caminhada em parques comuns à prática desta atividade. O formulário utilizado foi composto de questões sobre informações pessoais dos participantes, a rotina da prática de caminhada, o histórico de lesões e a presença de dor musculoesquelética no momento da entrevista. Foi realizada uma análise descritiva das características dos participantes e utilizado o teste t independente, teste de Mann-Whitney e teste de qui-quadrado para a comparação dos dados entre os participantes com dor e sem dor no momento da entrevista. Foram entrevistados 136 praticantes de caminhada, sendo que a prevalência de dor musculoesquelética foi de 8%. A articulação do joelho foi a região mais acometida pela dor entre os participantes (45%). Entre as variáveis analisadas, a presença de lesões prévias nos últimos 12 meses demostrou uma associação estatisticamente significativa (p<0,05) com a presença de dor atual. Podemos concluir que a prevalência de dor musculoesquelética em praticantes de caminhada é baixa, porém esteve diretamente associada à presença de lesões prévias nos últimos 12 meses.

The aim of this study was to determine the prevalence of musculoskeletal pain in walkers and the associated factors. This is a cross sectional study, conducted through a questionnaire applied to walkers in parks in which this activity is commonly seen. The form used was composed of questions about personal information, walking practice routine, injury history and the presence of musculoskeletal pain during the interview. We performed a descriptive analysis of the characteristics of the participants and used the independent t test, Mann-Whitney's test e chi-square test for the comparison of data between participants with and without pain at the moment of the interview. We interviewed 136 walkers, and the prevalence of musculoskeletal pain was 8%. The knee joint was the most affected region by pain between the participants (45%). Among the variables analyzed, the presence of previous injuries in the last 12 months showed a statistically significant association (p<0.05) with the presence of pain. We can conclude that the prevalence of musculoskeletal pain in walkers was low, however, it was directly associated with previous injuries in the last 12 months.

Este artículo tuvo el propósito de verificar la prevalencia de dolor musculo esquelético en practicantes de caminatas y los posibles factores asociados a esta práctica. Se trata de estudio transversal, que se realizó mediante un cuestionario aplicado a los practicantes de caminatas en parques y lugares que son comunes a esta actividad. El cuestionario se componía por informaciones personales de los practicantes, la rutina de la práctica, el historial de lesiones y la presencia de dolor musculo esquelético durante la entrevista. Para ello, se ha hecho un análisis descriptivo de las características de los participantes, y se han utilizados la prueba t independiente, la prueba de Mann-Whitney y la prueba de Chi Cuadrado para la comparación de los datos entre los participantes con y sin dolor en la ocasión de la entrevista. Se han entrevistados 136 practicantes de caminatas, y el 8% fue la prevalencia de dolor musculo esquelético encontrada. La zona más afectada por el dolor entre los participantes fue la articulación de rodilla (45%). Entre las variables evaluadas, se ha demostrado que la presencia de lesiones previas de los últimos 12 meses está asociada estadísticamente (p<0,05) a la presencia de dolor actual. Se concluyó que es baja la prevalencia de dolor musculo esquelético en practicantes de caminatas, sin embargo se la asocia a la presencia de lesiones previas de los últimos 12 meses.

Introdução:Lesões musculoesqueléticas ocorrem frequentemente na população de atletas de elite. Entender o que os profissionais que atuam com esporte de alto rendimento pensam sobre lesão e prevenção tem sido sugerido como um importante aspecto para se aumentar a eficácia de programas de prevenção de lesões no esporte.Objetivos: Descrever e caracterizar a opinião de fisioterapeutas, médicos e treinadores sobre fatores de risco e prevenção de lesões em atletas de elite.Método:Estudo qualitativo, realizado com entrevistas semiestruturadas numa parcela dos integrantes dos departamentos técnico e médico da delegação brasileira que participaram dos Jogos Pan-Americanos de Guadalajara 2011. A entrevista foi realizada a partir de duas perguntas: 1) O que você acha que pode causar lesões nos atletas da sua modalidade?, e 2) O que vocês fazem para a prevenção de lesões na sua modalidade?. As entrevistas foram analisadas em duas etapas, identificação das unidades temáticas, seguida da categorização e agrupamento de unidades temáticas.Resultados:Foram entrevistados um total de 30 profissionais. Em relação à pergunta 1, os principais fatores atribuídos como responsáveis pela lesão foram o excesso de treinamento e a técnica esportiva incorreta. Em relação à pergunta 2, as principais estratégias de prevenção de lesões utilizadas relatadas foram o fortalecimento muscular, o acompanhamento nutricional e orientações.Conclusões:Os principais fatores apontados para o surgimento de lesões foram excesso de treinamento, técnica esportiva incorreta, nutrição inadequada e fatores relacionados ao comportamento dos atletas. As principais estratégias de prevenção de lesões utilizadas foram fortalecimento muscular, acompanhamento nutricional e orientações.

Background:Musculoskeletal injuries occur frequently in elite athletes. Understanding what professionals who work with patients with sports injuries think about prevention has been suggested as an important aspect to improve the effectiveness of programs to prevent sports injuries.Objectives:To describe and characterize the opinions of physical therapists, physicians and trainers on 'risk factors' and 'prevention of injury' in elite athletes.Method: This is a qualitative study with semi-structured interviews with members of the medical and technical department of the Brazilian delegation who participated in the Pan American Games of Guadalajara 2011. The interview was conducted using two questions: 1) "What do you think can cause injuries in athletes participating in your sport?" 2) "What do you do to prevent injuries in your sport?" The interviews were analyzed in two stages, the identification of thematic units, followed by the categorization and grouping of thematic units.Results:We interviewed a total of 30 professionals. Regarding question 1, the main factors attributed as responsible for injury were over-training and incorrect sports techniques. Regarding question 2, the main reported strategies used to prevent injuries were muscle strengthening, nutritional counseling and guidance.Conclusions:The main factors affecting the appearance of lesions were over-training, incorrect sports technique, inadequate nutrition and factors related to the athlete's behavior. The main injury prevention strategies were muscle strengthening, nutritional counseling and guidance.

Background : While the research design of articles published in medical journals and in some physical therapy journals has already been evaluated, this has not been investigated in Brazilian physical therapy journals. Objective : To describe the research design used in all articles published in Brazilian scientific journals that are freely available, have high Qualis rankings, and are relevant to physical therapy over a 7-year period. Method : We extracted the bibliometric data, research design, research type (human or animal), and clinical area for all articles published. The articles were grouped into their level of evidence, and descriptive analyses were performed. We calculated the frequency, proportions of articles, and 95% confidence interval of these proportions with each research design in each journal. We cross-tabulated the clinical areas with research designs (expressed as number and percentages). Results : A total of 1,458 articles from four Brazilian journals were found: Revista Brasileira de Fisioterapia, Revista Fisioterapia em Movimento, Revista Fisioterapia e Pesquisa, and Revista Acta Fisiátrica. The majority of articles were classified as level II of evidence (60%), followed by level III (29%) and level I (10%). The most prevalent research designs were cross-sectional studies (38%), single-case or case-series studies, and narrative reviews. Most articles reported human research and were in the musculoskeletal, neurologic, and cardiothoracic areas. Conclusions : Most of the research published in Brazilian physical therapy journals used levels II and III of evidence. Increasing the publication rate of systematic reviews and randomized controlled trials would provide more high-quality evidence to guide evidence-based physical therapy practice.

INTRODUÇÃO: Embora o tratamento conservador ainda seja a melhor conduta inicial para a epicondilite lateral do cotovelo, há pouca evidência científica de que o tratamento fisioterapêutico altere o curso natural da doença e seja efetiva no tratamento dessa patologia. OBJETIVO: Avaliar a efetividade e a segurança das diversas intervenções fisioterapêuticas utilizadas no tratamento conservador da epicondilite lateral. MATERIAIS E MÉTODOS: Foram incluídos apenas ensaios clínicos aleatorizados e quase aleatorizados que utilizaram pelo menos uma modalidade fisioterapêutica como uma das intervenções. Foi realizada uma busca nas bases de dados eletrônicos MEDLINE; Embase; LILACS e SciELO até dezembro de 2010. Não houve restrição do período de publicação dos artigos. Com o objetivo de aumentar a sensibilidade e a precisão, a estratégia de busca utilizada foi adaptada para cada base de dados. Foi utilizada a pontuação da escala PEDro para avaliação da qualidade metodológica dos ensaios clínicos aleatorizados. RESULTADOS: 26 artigos foram incluídos na revisão sistemática e a avaliação da maioria desses artigos apresentou qualidade metodológica satisfatória (6,4 pontos). Em relação aos aspectos mensurados, todos os artigos avaliaram a dor, 18 (69%) examinaram a força de preensão e 11 (42%) a função dos pacientes. Quanto à duração do acompanhamento dos pacientes apenas nove (35%) artigos realizaram acompanhamento a longo prazo. CONCLUSÃO: A melhor opção para o tratamento da epicondilite lateral parece ser a combinação de modalidades terapêuticas, o que condiz com a realidade clínica do fisioterapeuta. Porém, mais ensaios clínicos com boa qualidade metodológica são necessários para determinar a efetividade da maioria das modalidades terapêuticas encontradas.

INTRODUCTION: Although conservative treatment is still the best initial management for lateral epicondylitis, there is little scientific evidence that physical therapy change the natural history of disease and is effective for treating this condition. Objective: evaluate the effectiveness and safety of different physical therapy interventions used in the conservative treatment of lateral epicondylitis. MATERIALS AND METHODS: We included only randomized controlled trials and quasi-randomized studies that used at least one modality of physical therapy as an intervention. We performed a search of electronic databases MEDLINE, Embase, LILACS and SciELO by December 2010. There was no restriction of the period and publication of articles aiming to increase the sensitivity and accuracy; the search strategy used was adapted for each database. We used the score of the PEDro scale for assessing the methodological quality of randomized controlled trials. RESULTS: 26 articles were included in the systematic review, and the evaluation of most of these articles had satisfactory methodological quality (6.4 points). Regarding the aspects measured, all articles evaluated pain, 18 (69%) examined the grip strength and 11 (42%) examined the patient's function. The duration of follow-up, only nine (35%) articles made long-term monitoring. CONCLUSION: The best option for the treatment of lateral epicondylitis seems to be a combination of therapeutic modalities, which agrees with clinical reality of the physiotherapists. However, more clinical trials with good methodological quality are needed to determine the effectiveness of most therapeutic modalities found.

A participação em corridas de rua vem aumentando significativamente nos últimos anos, motivada pelos benefícios a saúde, fácil execução e baixo custo. Os objetivos desse estudo foram: analisar a prevalência de dor musculoesquelética em corredores de rua no momento em que precede o início da prova, além de discutir alguns fatores etiológicos relacionados à prática da corrida. Os participantes foram divididos em dois grupos, um grupo foi composto por corredores com queixa de dor musculoesquelética e outro sem queixa. Foi constatada uma diferença estatisticamente significante quando comparados o número de treinos por semana (p=0,03) e a quilometragem semanal percorrida (p=0,01). Concluímos que a prevalência de dor foi de aproximadamente 25% e estava diretamente associada ao volume de treino semanal.

The participation in running has increase significantly motivated by the health benefits, easy execution and low cost. The aims of this study were to calculate the prevalence of presence of musculoskeletal pain in recreational runners immediately before a race and discuss the some hypothesis of it. The participants were divided into two groups. The first one composed for runners with musculoskeletal pain complaints and the other group without any complaints. We found a statistical relationship when compare the number of training per week (p=0,03) and weekly distance (p=0,01). We conclude that prevalence of pain was about 25% and was directly associated with weekly training volume.

La participación en las carreras de atletismo de larga distancia que se realizan en circuitos urbanos ha aumentado considerablemente en los últimos años, motivada por los beneficios en la salud, su fácil ejecución y su bajo costo. Este estudio tuvo como objetivo analizar la prevalencia de dolor musculoesquelético en corredores previo al inicio de las carreras, y discutir algunos de los factores etiológicos relacionados con la práctica de las carreras de larga distancia. Los participantes se dividieron en dos grupos; un grupo estaba compuesto por los corredores que indicaron presencia de dolor musculoesquelético y el otro grupo por los que no presentaron dolor. Se encontró una diferencia estadísticamente significativa al comparar el número de entrenamientos por semana (p = 0,03) y el kilometraje recorrido semanalmente (p = 0,01). Se concluye que la prevalencia de dolor fue alrededor del 25%, asociada directamente con el volumen de entrenamiento semanal.