Aspectos da função muscular em mulheres com dor femoropatelar e suas implicações no padrão de movimento durante a subida de escada
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Data
2018-05-11
Autores
Ferreira, Amanda Schenatto
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A Dor Femoropatelar (DFP) acomete com maior frequência mulheres e é exacerbada ao executar atividades com suporte de peso associada a flexão do joelho, tais como subida de escada. Apesar da etiologia permanecer indefinida, diversos fatores são atribuídos ao desenvolvimento da DFP, dentre os quais destaca-se a diminuição do torque dos músculos do joelho e quadril. Entretanto, os tratamentos que visam o fortalecimento dessa musculatura nem sempre apresentam resultados eficazes a longo prazo. Dessa forma, outros importantes aspectos da função muscular podem estar sendo negligenciados e necessitam ser investigados, tais como a estabilidade do torque e a taxa de desenvolvimento do torque (potência muscular). Diante disso, os objetivos gerais desta dissertação foram investigar a estabilidade do torque, taxa de desenvolvimento do torque e torque máximo dos músculos extensores de joelho e abdutores de quadril em mulheres com DFP, além de determinar a influência do torque muscular do quadril e da cinemática do retropé no padrão de movimento durante atividade funcional de subida de escada. A mensuração das variáveis de torque foi realizada através de dinamômetro isocinético. Já a análise cinemática foi realizada durante subida de escada em um set up experimental composto por 9 câmeras infravermelho para captação de ângulos articulares do quadril e retropé. Observou-se que mulheres com DFP apresentam diminuição da estabilidade do torque, taxa de desenvolvimento do torque e torque máximo nos músculos extensores de joelho e abdutores de quadril em comparação a mulheres assintomáticas. Além disso, o torque muscular máximo do quadril foi capaz de predizer de forma significativa o padrão de movimento alterado durante a subida de escada em mulheres com DFP. De acordo com estes resultados observa-se que importantes aspectos da função muscular têm sido negligenciados na literatura da DFP e precisam ser considerados durante a avaliação do indivíduo com DFP. Nesse sentido, exercícios de fortalecimento dos músculos do joelho e quadril associados a intervenções direcionadas a melhora da estabilidade do torque e potência muscular podem ser promissores para o tratamento da DFP.
Patellofemoral pain is more likely to affect women. Pain is exacerbated by activities that load the patellofemoral joint during weight bearing on a flexed knee, such as stair ascent. Despite the source of pain remains unclear, multiple factors have been proposed to explain the development of PFP, especially the impairment in knee and hip maximal strength. However, unfavorable recovery has been reported even after treatments focused on quadriceps and hip strengthening. Thus, other aspects of muscular function are possibly being neglected and should be better explored in PFP, such as force steadiness and rate of force development (muscle power). Therefore, the aims of this dissertation were to compare force steadiness, rate of force development and maximal strength of the knee extensors and hip abductors between women with PFP and pain-free controls and to investigate the influence of hip muscle strength and rearfoot kinematics on the movement pattern during stair ascent in women with PFP. Strength parameters were assessed using an isokinetic dynamometer. Kinematic analysis was performed during stair ascent tasks in an experimental set up composed by 9 cameras for acquisition of hip and rearfoot eversion joint angles. Women with PFP presented deficits in force steadiness, rate of force development and maximal strength of knee extensors and hip abductors compared with pain-free controls. Also, hip abductor strength explained significantly the variance of peak hip internal rotation during stair ascent in all women with PFP. These findings highlight that important components of muscle function have been neglected in PFP literature and should be considered during assessment of women with PFP. Therefore, evidence-based treatments aiming at improving force steadiness and muscle power may be a promising addition to the usual protocols of knee and hip strengthening for PFP management.
Patellofemoral pain is more likely to affect women. Pain is exacerbated by activities that load the patellofemoral joint during weight bearing on a flexed knee, such as stair ascent. Despite the source of pain remains unclear, multiple factors have been proposed to explain the development of PFP, especially the impairment in knee and hip maximal strength. However, unfavorable recovery has been reported even after treatments focused on quadriceps and hip strengthening. Thus, other aspects of muscular function are possibly being neglected and should be better explored in PFP, such as force steadiness and rate of force development (muscle power). Therefore, the aims of this dissertation were to compare force steadiness, rate of force development and maximal strength of the knee extensors and hip abductors between women with PFP and pain-free controls and to investigate the influence of hip muscle strength and rearfoot kinematics on the movement pattern during stair ascent in women with PFP. Strength parameters were assessed using an isokinetic dynamometer. Kinematic analysis was performed during stair ascent tasks in an experimental set up composed by 9 cameras for acquisition of hip and rearfoot eversion joint angles. Women with PFP presented deficits in force steadiness, rate of force development and maximal strength of knee extensors and hip abductors compared with pain-free controls. Also, hip abductor strength explained significantly the variance of peak hip internal rotation during stair ascent in all women with PFP. These findings highlight that important components of muscle function have been neglected in PFP literature and should be considered during assessment of women with PFP. Therefore, evidence-based treatments aiming at improving force steadiness and muscle power may be a promising addition to the usual protocols of knee and hip strengthening for PFP management.
Descrição
Palavras-chave
Dor anterior de joelho, Torque muscular, Cinemática, Anterior knee pain, Muscular strength, Kinematic