Efeitos imediatos da terapia por compressão manual e por ondas de choque em pontos gatilhos miofasciais: ensaio clínico randomizado
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2022-12-21
Autores
Kuroda, Melissa Nahomi
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O Ponto Gatilho Miofascial (PGM) é definido como um ponto hiper irritável localizado em uma banda muscular tensa. Diversas formas de tratamento vêm sendo estudadas e utilizadas, dois recursos em evidência são a Compressão Isquêmica (CI) e a Terapia por Ondas de Choque (TOC). Entretanto, ainda há uma falta de informações sobre quais são os melhores parâmetros e recursos para o tratamento do PGM. Objetivo: Comparar os efeitos agudos da CI e TOC no tratamento de PGM no gastrocnêmio. Método: A amostra foi composta por 59 atletas, de elite a recreativos, de diversas modalidades, com média de 23,15 ± 4,80 anos e de ambos os sexos que apresentaram PGM no gastrocnêmio. Foi realizada uma anamnese e avaliação para a comprovação da presença de PGM por meio de palpação. Também foi realizada a avaliação do limiar de dor por pressão pela algometria; da amplitude de dorsiflexão de tornozelo pelo Weight-Bearing Lunge Test e o aplicativo Clinometer® ; do desempenho por meio da análise do salto pela plataforma de contato Elite Jump System® e da dinamometria isocinética realizada pelo dinamômetro Biodex® System. Posteriormente, para intervenção, os participantes foram divididos aleatoriamente em Grupo Compressão Isquêmica (GCI) que foi submetido a dígito pressão sobre os ponto; e Grupo Terapia Ondas de Choque (GTOC) com a aplicação de 2000 disparos em cada ponto a 10Hz e uma densidade de fluxo de energia de 60 mJ/mm2 sobre os PGM. As avaliações ocorreram em três momentos: basal (T0); imediatamente após intervenção (T1) e após 48 horas (T2). A análise dos dados, foi realizada pelo software SPSS, versão 22.0 (SPSS Inc, Chicago, IL), após confirmação da normalidade na distribuição dos dados e homogeneidade das variâncias, foi selecionado a ANOVA de medidas repetidas. Resultados: Não houve diferenças estatísticas para as variáveis de limiar de dor por pressão e amplitude de movimento de dorsiflexão do tornozelo. Na medida do salto houve efeito principal de momento com T1 menor que T0 (p=0,001) e T2 maior que T1 (p=0,000), indicando que houve uma diminuição da altura do salto imediatamente após a intervenção, seguida de uma melhora além dos valores de base. Por fim, na dinamometria isocinética, houve efeito principal de momento apenas na medida de potência no movimento de flexão plantar (T0 menor que T1 (p=0,002)), interação grupo*momento na GCI para a potência (T0 menor que T1 (p=0,026)). Conclusão: Ambas as técnicas não apresentaram efeito a curto prazo no limiar de dor, na ADM e na força de flexão plantar, sem superioridade entre as técnicas
Introduction: The Myofascial Trigger Point (MTrPs) is defined as a hyperirritable point located in a tense muscle band. Several forms of treatment have been studied and used, two resources in evidence are Ischemic Compression (IC) and Shock Wave Therapy (TOC). However, there is still a lack of information about the best parameters and resources for treating MTrPs. Objective: To compare the acute effects of IC and TOC in the treatment of MTrPs. Method: The sample consisted of 59 athletes, elite and competitive, from different modalities, age of 23,15 ± 4,80 years, and of both genders who present MTrPs in the gastrocnemius. An anamnesis was carried out followed by the evaluation protocol to prove the presence of MTrPs through palpation. Pain threshold assessment by algometry was also performed; ankle dorsiflexion range using the Weight-Bearing Lunge Test and the Clinometer® application; performance through analysis of the jump using the Elite Jump System® contact platform and isokinetic dynamometry performed using the Biodex® System dynamometer. Subsequently, for intervention, participants were randomly divided into the Ischemic Compression Group (ICG), which were subjected to digital pressure only once at each point; and Shockwave Therapy Group (GTOC) with the application of 2000 shots at each point at 10Hz and an energy flow density of 60 mJ/mm2 on the MTrPs. Assessments take place at three moments: baseline (T0); immediately after intervention (T1) and after 48 hours (T2). Data analysis was performed using the SPSS software, version 22.0 (SPSS Inc, Chicago, IL). After confirmation of normality in data distribution and homogeneity of variances, repeated measures ANOVA with the Bonferroni test was selected. Results: There were no statistical differences for pressure pain threshold and ankle dorsiflexion range of motion. In terms of jumping, there was a main effect of moment with T1 smaller than T0 (p=0.001) and T2 greater than T1 (p=0.000), indicating that there was a decrease in the height of the jump immediately after the intervention, followed by an improvement beyond the base values. Finally, in isokinetic dynamometry, there was a main effect of moment only in the power measure in the plantar flexion movement (T0 less than T1 (p=0.002)), group*moment interaction in IC for power (T0 less than T1 (p =0.026)). Conclusion: Both techniques had no short-term effect on pain threshold, dorsiflexion ROM and plantar flexion strength, with no superiority between techniques
Introduction: The Myofascial Trigger Point (MTrPs) is defined as a hyperirritable point located in a tense muscle band. Several forms of treatment have been studied and used, two resources in evidence are Ischemic Compression (IC) and Shock Wave Therapy (TOC). However, there is still a lack of information about the best parameters and resources for treating MTrPs. Objective: To compare the acute effects of IC and TOC in the treatment of MTrPs. Method: The sample consisted of 59 athletes, elite and competitive, from different modalities, age of 23,15 ± 4,80 years, and of both genders who present MTrPs in the gastrocnemius. An anamnesis was carried out followed by the evaluation protocol to prove the presence of MTrPs through palpation. Pain threshold assessment by algometry was also performed; ankle dorsiflexion range using the Weight-Bearing Lunge Test and the Clinometer® application; performance through analysis of the jump using the Elite Jump System® contact platform and isokinetic dynamometry performed using the Biodex® System dynamometer. Subsequently, for intervention, participants were randomly divided into the Ischemic Compression Group (ICG), which were subjected to digital pressure only once at each point; and Shockwave Therapy Group (GTOC) with the application of 2000 shots at each point at 10Hz and an energy flow density of 60 mJ/mm2 on the MTrPs. Assessments take place at three moments: baseline (T0); immediately after intervention (T1) and after 48 hours (T2). Data analysis was performed using the SPSS software, version 22.0 (SPSS Inc, Chicago, IL). After confirmation of normality in data distribution and homogeneity of variances, repeated measures ANOVA with the Bonferroni test was selected. Results: There were no statistical differences for pressure pain threshold and ankle dorsiflexion range of motion. In terms of jumping, there was a main effect of moment with T1 smaller than T0 (p=0.001) and T2 greater than T1 (p=0.000), indicating that there was a decrease in the height of the jump immediately after the intervention, followed by an improvement beyond the base values. Finally, in isokinetic dynamometry, there was a main effect of moment only in the power measure in the plantar flexion movement (T0 less than T1 (p=0.002)), group*moment interaction in IC for power (T0 less than T1 (p =0.026)). Conclusion: Both techniques had no short-term effect on pain threshold, dorsiflexion ROM and plantar flexion strength, with no superiority between techniques
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Palavras-chave
Pontos Gatilho, Atletas, Tratamento por ondas de choque extracorpóreas, Dor, Manipulações musculoesqueléticas, Fisioterapia, Eletroterapia, Trigger points, Massagem esportiva, Extracorporeal shockwave therapy, Pain, Athletes, Musculoskeletal manipulations