Background The effectiveness of blood flow restriction training (BFR) in elderly with knee osteoarthritis (OA) is comparable to performing high-intensity protocols (70 to 80% of 1 RM [repetition maximum]) that are known to be effective for improving the muscle strength of knee extensors, with the advantage of generating less particular rating of perceived exertion and pain immediately after training. However, despite being a promising alternative, little is known about the best way to apply the BFR, such as level of pressure and combination or not with other therapeutic modalities. The purpose of this study is to evaluate whether different levels of blood flow restriction with low load (BFR + LL) and no load (BFR + rest) are non-inferior to high-intensity resistance exercise (HIRE+BFRplacebo) for pain reduction in patients with knee OA. Methods/design This clinical trial is a non-inferiority, five-arm, randomized, active-controlled, single trial which will be carried out in 165 patients of both sexes with knee OA, aged 50 years and older. Participants will be randomly allocated into 5 exercise groups (40% of BFR + LL; 80% of BFR + LL; 40% of BFR + rest; 80% BFR + rest, and HIRE+BFR placebo). A mixed linear model will be used to examine the effect of group-by-time interaction on pain intensity on the WOMAC subscale (primary outcome) and on disease severity, physical functional data, balance data, quality of life, global perceived effect scale, and muscle strength (secondary outcomes). Participants will be analyzed for intention-to-treat, and the statistical assessor blinded to the groups. The collection of outcomes 72 h after completion of the 16 weeks of interventions will be the primary measurement point. Follow-up secondary timepoints will be collected at 20, 28, 40, 52, and 64 weeks after the end of interventions, except for pain during the training, which will be measured immediately at the end of each session. Only the comparison of the primary outcome between the HIRE group with each BFR group will be analyzed in the non-inferiority framework, the other comparisons between the BFR groups for the primary outcome, and all secondary outcomes will be interpreted in the superiority framework. Discussion The results of this clinical trial can point out more clearly to ways to optimize the BFR training with the minimum of pain immediately after training, which will allow the offer of an effective and more adherent strengthening training to patients with knee OA. Trial registration Registro Brasileiro de Ensaios Clínicos, RBR-93rx9q. Registered on 23 July 2020. Version 1.0.

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The purpose of this study was to investigate the strength and ratios of the plantar flexors and ankle dorsiflexors in recreational runners with medial tibial stress syndrome and to assess the association between muscle strength and the level of pain in this population. Methods: Two groups (control and medial tibial stress syndrome) of eighteen runners each participated in this cross-sectional study. Isokinetic dynamometry was used to evaluate muscle strength, and for the analysis, the normalized isokinetic peak torque controlled by gender was used. Results: The medial tibial stress syndrome group showed lower normalized isokinetic peak torque in the dorsiflexors in the concentric (p = 0.008) eccentric (p = 0.011) contraction, as well as a lower plantar flexor, normalized isokinetic peak torque in the concentric (p = 0.001) and eccentric (p = 0.02) when compared to the control group. However, there was no difference in the normalized isokinetic peak torque ratio representative of the stance (p = 0.62) and swing phase (p = 0.16), and the level of pain was not correlated with the strength concentric (p = 0.32) and eccentric (p = 0.621) of plantar flexors, nor to the concentric (p = 0.21) and eccentric of dorsiflexors (p = 0.54). Conclusion: Recreational runners with MTSS showed decreased muscle strength in the sagittal plane of the ankle, no correlation with the level of pain, and no changing the ratio between plantar flexors and dorsiflexors.

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