A alteração na modulação do reflexo-H é um fator de risco para dor femoropatelar?
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Data
2019-11-06
Autores
Pazzinatto, Marcella Ferraz
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A dor femoropatelar (DFP) é uma das condições mais comuns na prática ortopédica, e evidências recentes sugerem que pode ser um fator predisponente à osteoartrite femoropatelar. Além das alterações biomecânicas associadas ao patomecanismo subjacente à DFP, a investigação de alterações neurofisiológicas pode fornecer novas informações no entendimento da fisiopatologia da DFP. Nesse sentido, o reflexo de Hoffmann (reflexo-H), o homólogo elétrico do reflexo de estiramento, tem sido utilizado na tentativa de entender melhor como o sistema nervoso central integra os sinais descendentes com os aferentes periféricos, como uma medida indireta da excitabilidade espinal. Esta tese teve como objetivo investigar de forma abrangente o papel do reflexo H em mulheres com DFP. Primeiramente, um estudo transversal foi proposto com o objetivo de facilitar a implementação de medidas neurofisiológicas no ambiente clínico, através da avaliação do reflexo tendíneo (reflexo-T), utilizando um martelo clínico simples. Os resultados deste e de outros estudos previamente publicados pelo nosso grupo de pesquisa instigaram os autores a levantar a hipótese de que a menor amplitude do reflexo-H seja um fator de risco ou uma consequência da DFP. Para responder a essa pergunta, os autores propuseram um estudo prospectivo de coorte observacional de 1 ano. Diante dos resultados apresentados nesta tese, entende-se a contribuição dos aspectos neurofisiológicos na DFP.
Patellofemoral pain (PFP) is one of the most common conditions in orthopedic practice while recent evidence has suggested that it may be a predisposing factor to patellofemoral osteoarthritis. In addition to biomechanical alterations associated with the pathomechanisms underlying PFP, the investigation of neurophysiological alterations might provide novel information in the understanding of the pathophysiology of PFP. In this direction, the Hoffmann reflex (H-reflex), the electrical homologous of the stretch reflex, has been used in an attempt to better understand how the central nervous system integrates the descending signals with those coming from the periphery, it has been used as an indirect measurement of spinal excitability. This thesis aimed to comprehensively investigate the role of the H-reflex in women with PFP. Firstly, a cross-sectional study was proposed aiming to facilitate the implementation of neurophysiological measures in the clinical setting through the assessment of the tendon reflex (T-reflex) using a simple clinical hammer. Findings from these and other previous studies instigated the authors to raise the hypothesis whether lower H-reflex is a risk factor or a consequence of PFP. In order to answer this question, the authors proposed a 1-year prospective observational cohort study. Given the results presented in this thesis, we understand the contribution of neurophysiological aspects in PFP.
Patellofemoral pain (PFP) is one of the most common conditions in orthopedic practice while recent evidence has suggested that it may be a predisposing factor to patellofemoral osteoarthritis. In addition to biomechanical alterations associated with the pathomechanisms underlying PFP, the investigation of neurophysiological alterations might provide novel information in the understanding of the pathophysiology of PFP. In this direction, the Hoffmann reflex (H-reflex), the electrical homologous of the stretch reflex, has been used in an attempt to better understand how the central nervous system integrates the descending signals with those coming from the periphery, it has been used as an indirect measurement of spinal excitability. This thesis aimed to comprehensively investigate the role of the H-reflex in women with PFP. Firstly, a cross-sectional study was proposed aiming to facilitate the implementation of neurophysiological measures in the clinical setting through the assessment of the tendon reflex (T-reflex) using a simple clinical hammer. Findings from these and other previous studies instigated the authors to raise the hypothesis whether lower H-reflex is a risk factor or a consequence of PFP. In order to answer this question, the authors proposed a 1-year prospective observational cohort study. Given the results presented in this thesis, we understand the contribution of neurophysiological aspects in PFP.
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Palavras-chave
Dor femoropatelar, Fisioterapia, Excitabilidade espinal, Biomecânica