Análise do movimento e do desempenho físico de mulheres com dor patelofemoral
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Data
2022-04-28
Autores
Morita, Ângela Kazue
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Universidade Estadual Paulista (Unesp)
Resumo
Diversas alterações cinemáticas e da função neuromuscular foram descritas na literatura e apontadas como possíveis causas da dor patelofemoral (DP). A literatura mostra que o padrão cinemático não está associado ao nível de força ou de ativação muscular na DP. É possível que essas alterações contribuam de formas distintas e que existam subgrupos de sujeitos com DP, com alterações cinemáticas que não sejam proporcionais à deficiência neuromuscular. Ainda, pouco se sabe sobre a cinemática do plano sagital de atividades cotidianas, que necessita ser investigada, visto que 24% dos sujeitos com DP são sedentários. O objetivo geral da presente tese foi investigar os possíveis mecanismos subjacentes da DP em mulheres. No primeiro artigo, foi verificado que as mulheres com DP apresentam aumento da inclinação posterior do tronco e da anteriorização do joelho, comparadas às assintomáticas, ao desempenharem os testes de agachamento unipodal e descida do degrau (p < 0,05). Foi verificado também que o aumento da inclinação posterior do tronco se correlaciona com o aumento da anteriorização do joelho e da dorsiflexão do tornozelo, em ambas as tarefas (p < 0,05). Conclui-se que as mulheres com DP apresentam alterações dos movimentos sagitais do tronco e do joelho, ao desempenharem atividades funcionais, e que os movimentos neste plano são interdependentes. No segundo artigo, foi observado que, em mulheres com DP, o aumento do valgo dinâmico do joelho foi predito (R2= 0,39) pelo aumento da ativação do glúteo médio (β= 0,23) e do torque isométrico dos abdutores do quadril (β= 0,08), enquanto nas assintomáticas, foi predito (R2= 0,16) pelo aumento do torque isométrico dos abdutores do quadril (β= 0,07); quanto ao aumento da inclinação posterior do tronco, houve modelo significativo somente para as assintomáticas, que foi predito (R2= 0,24) pelo aumento da ativação do vasto medial oblíquo (β= 0,12) (p < 0,05). Conclui-se que a cinemática é predita pelas capacidades dos músculos que atuam nos respectivos planos e que a alteração cinemática não está relacionada à fraqueza muscular na DP. No terceiro artigo, foram identificados três subgrupos de mulheres com DP: o primeiro anteriorizou o joelho em demasia e mostrou força e resistência lateral do tronco diminuídas; o segundo apresentou valgo de joelho acentuado, porém força e resistência do tronco e membro inferior preservadas; o terceiro também mostrou valgo acentuado, porém exibiu força e resistência diminuídas. Conclui-se que as alterações cinemáticas do joelho não são foram acompanhadas por padrões do nível de força ou de resistência muscular do tronco e membro inferior na DP.
Several kinematic and neuromuscular function alterations have been described in the literature and identified as possible causes of patellofemoral pain (PP). The literature shows that the kinematic pattern is not associated with strength or muscle activation levels in PP. It is possible that these alterations contribute to different ways and there are subgroups of subjects with PP, with kinematic alterations that are not proportional to the neuromuscular deficit. Furthermore, little is known about the sagittal plane kinematics of daily activities, which require to be investigated, since 24% of subjects with PP are sedentary. The general objective of the present thesis was to investigate the possible subjacent mechanisms of PP in women. In the first article, it was found that women with PP present increased posterior trunk lean and anterior knee displacement, compared to asymptomatic women, when performing the single-leg squat and step down tests (p < 0.05). It was also verified that the increase in posterior trunk lean is correlated with the increase in anterior knee displacement and ankle dorsiflexion, in both tasks (p < 0.05). It is concluded that women with PP present changes in sagittal movements of the trunk and knee, when performing functional activities, and the movements in this plane are interdependents. In the second article, it was observed that, in women with PP, the increase in dynamic knee valgus was predicted (R2= 0.39) by the increase in gluteus medius activation (β= 0.23) and isometric torque of the hip abductors (β= 0.08), while in asymptomatic patients, it was predicted (R2= 0.16) by the increase in isometric torque of the hip abductors (β= 0.07); regarding the increase in posterior trunk lean, there was a significant model only for asymptomatic women, which was predicted (R2= 0.24) by the increase in the activation of the vastus medialis oblique (β= 0.12) (p < 0.05). It is concluded that the kinematics is predicted by the capacities of the muscles that act in the respective planes and that the kinematic alteration is not related to muscle weakness in PP. In the third article, three subgroups of women with PP were identified: the first overly forwarded the knee and showed reduced lateral trunk strength and resistance; the second presented excessive knee valgus, but the strength and resistance of the trunk and lower limb were preserved; the third also showed excessive valgus, but exhibited diminished strength and endurance. It is concluded that the kinematic changes of the knee were not accompanied by patterns of strength level or muscular resistance of the trunk and lower limb in PP.
Several kinematic and neuromuscular function alterations have been described in the literature and identified as possible causes of patellofemoral pain (PP). The literature shows that the kinematic pattern is not associated with strength or muscle activation levels in PP. It is possible that these alterations contribute to different ways and there are subgroups of subjects with PP, with kinematic alterations that are not proportional to the neuromuscular deficit. Furthermore, little is known about the sagittal plane kinematics of daily activities, which require to be investigated, since 24% of subjects with PP are sedentary. The general objective of the present thesis was to investigate the possible subjacent mechanisms of PP in women. In the first article, it was found that women with PP present increased posterior trunk lean and anterior knee displacement, compared to asymptomatic women, when performing the single-leg squat and step down tests (p < 0.05). It was also verified that the increase in posterior trunk lean is correlated with the increase in anterior knee displacement and ankle dorsiflexion, in both tasks (p < 0.05). It is concluded that women with PP present changes in sagittal movements of the trunk and knee, when performing functional activities, and the movements in this plane are interdependents. In the second article, it was observed that, in women with PP, the increase in dynamic knee valgus was predicted (R2= 0.39) by the increase in gluteus medius activation (β= 0.23) and isometric torque of the hip abductors (β= 0.08), while in asymptomatic patients, it was predicted (R2= 0.16) by the increase in isometric torque of the hip abductors (β= 0.07); regarding the increase in posterior trunk lean, there was a significant model only for asymptomatic women, which was predicted (R2= 0.24) by the increase in the activation of the vastus medialis oblique (β= 0.12) (p < 0.05). It is concluded that the kinematics is predicted by the capacities of the muscles that act in the respective planes and that the kinematic alteration is not related to muscle weakness in PP. In the third article, three subgroups of women with PP were identified: the first overly forwarded the knee and showed reduced lateral trunk strength and resistance; the second presented excessive knee valgus, but the strength and resistance of the trunk and lower limb were preserved; the third also showed excessive valgus, but exhibited diminished strength and endurance. It is concluded that the kinematic changes of the knee were not accompanied by patterns of strength level or muscular resistance of the trunk and lower limb in PP.
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Palavras-chave
Amplitude de movimento articular, Eletromiografia, Dinamômetro de força muscular, Dor musculoesquelética, Joint range of motion, Electromyography, Muscle strength dynamometer, Musculoskeletal pain