Efeitos da mobilização miofascial plantar no equilíbrio corporal, mobilidade funcional e ativação muscular em idosas
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2016-02-12
Autores
Marques, Ana Elisa Zuliani Stroppa [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A manutenção da postura ortostática revela um comportamento inerente ao ser humano, de oscilação postural. Essa contínua oscilação, fornece input vindo da área plantar, para ativação do sistema nervoso central, que resulta em ajustes na manutenção da postura em equilíbrio. O aumento na ativação muscular é uma importante estratégia para suprir a instabilidade, sendo o músculo trapézio superior (TS) um importante marcador de controle postural. No idoso as estratégias de manutenção da postura ficam comprometidas, o que aumenta o risco de quedas e compromete a mobilidade funcional. Assim, entende-se que a qualidade do apoio plantar pode auxiliar a população idosa na manutenção da postura em equilíbrio e menor necessidade de ativação muscular. O objetivo desse estudo foi verificar o efeito da manobra de mobilização miofascial plantar na área de apoio dos pés, bem como a implicação das variações do suporte plantar em postura ortostática, no tempo de manutenção das posturas, no equilíbrio, na mobilidade funcional, na ativação do músculo trapézio superior de idosas. Foram recrutadas por triagem, 28 idosas saudáveis, com 69,03 ±3,32 anos, e divididas aleatoriamente em dois grupos: Manobra (GM) com 15 idosas e Sham (GS) com 13 idosas . O protocolo de manobra foi aplicado, pelo mesmo avaliador, bilateralmente com 5 repetições, divididos em duas semanas. Para o GM foi realizado deslizamentos plantar com vigorosa pressão das mãos do pesquisador, no intuito de alcançar a musculatura intrínseca do pé. No GS, a manobra foi realizada de forma suave, auxiliado por óleo de massagem, para favorecer o deslizamento na pele. A análise dos dados aconteceu em três momentos diferentes: momento antes da primeira manobra (pré), imediatamente após (pós) e no último dia de coleta (D6). Os resultados foram divididos em dois estudos. O estudo1 analisou dados de avaliação de área e de arco plantar, índice do arco plantar, tempo de manutenção na postura unipodal com olhos abertos (TAUoa) e fechados (TAUof) e o teste de mobilidade funcional – Timed Up and Go (TUG). O estudo 2 analisou dados da avaliação como área plantar, e tempo de manutenção nas posturas mais desafiadoras, ativação eletromiográfica do músculo TS no momento pré intervenção, em variações do apoio plantar e após o protocolo de mobilização. No estudo 1 houve significativo aumento, nas condições após a intervenção, somente para o GM, para a área de contato plantar em ambos os pés (F=7,577, p=0,001), no TUG (F=15,099, p<0,001), no TAUoa (F=14,592, p<0,0001) e TAUof (F=3,398, p=0,048) o que mostra efeito benéfico da técnica de mobilização miofascial plantar para o aumento de área de contato, equilíbrio e mobilidade funcional. No estudo 2 houve aumento da atividade eletromiográfica com a redução da base de apoio para os olhos abertos (F=7,456; p=0,0002) e fechados (F=23,019, p<0,0001). Nas condições olhos abertos e fechados notaram-se valores significativos (p<0,0001) para tandem e unipodal. Houve significativo aumento para o GM, para a área de contato plantar em ambos os pés (F=7,577, p=0,001) e pé direito (F=5,332, p=0,011), o tempo de manutenção das posturas desafiadoras mostrou resultados significativos no momento pós (p<0,05), no GM, para tandem complacente olho fechado e para as duas condições em unipodal; já para o D6 o as posturas em tandem rígida olho fechado e unipodal olho aberto foram significativos. Os dados da atividade mioelétrica normalizados não apresentaram significância estatística. Os resultados deste estudo apresentaram efeitos benéficos da manobra de mobilização miofascial plantar para todas as variáveis estudadas, exceto para a ativação do músculo trapézio superior após a aplicação dos protocolos de mobilização.
Maintaining upright posture reveals an inherent to the human behavior, of postural sway. This continuous oscillation, provides input from the plantar area, for activating the central nervous system, resulting in adjustments to maintain posture in balance. The increase in muscle activation is an important strategy to address instability, and the upper trapezius muscle (UT) an important reference for postural control. In the elderly the position of maintenance strategies are compromised, which increases the risk of falls and compromises functional mobility. Thus, it is understood that the quality of support plant can help the elderly population in the maintaining of posture and less need for muscle activation. The aim of this study was to investigate the effect of maneuver planting myofascial mobilization the feet support area, as well as the involvement of variations of feet support in standing position at the time of maintenance of posture, balance, functional mobility, activation the upper trapezius muscle older. Were recruited for screening, 28 healthy older, with 69.03 ± 3.32 years, and randomly divided into two groups: Maneuver (MG) with 15 elderly and Sham (SG) with 13 elderly. The protocol was applied by the same appraiser, bilaterally, with 5 repetitions, divided into two weeks. For MG was conducted landslides plant with vigorous pressure from the hands of the researcher in order to reach the intrinsic muscles of the foot. In SG, the maneuver was carried out smoothly, aided by massage oil to encourage the slip on the skin. The data analysis took place in three different moments: the moment before the first maneuver (pre), immediately after (post) and on the last day of collection (D6). The results were divided into two studies. The study1 examined area of assessment data and plantar arch, plantar arch index, downtime in single leg stance with eyes open (SLSeo) and closed (SLSec) and functional mobility test - Timed Up and Go (TUG). Study 2 analyzed assessment data as plantar area, and downtime in the most challenging postures, electromyographic activation of the UT muscle in pre intervention time, in support of changes to plant and after mobilization protocol. In Study 1 there were significant increases in the conditions after the intervention only for the MG to contact plantar area of both feet (F = 7.577, p = 0.001) in the TUG (F = 15.099, p <0.001) in SLSeo (F = 14.592, p <0.0001) and SLSec (F = 3.398, p = 0.048) showing the beneficial effect of plant myofascial mobilization technique for increasing the contact area, balance and functional mobility. In study 2 showed an increase in electromyographic activity with reduced support base to open eyes (F = 7.456; p = 0.0002) and closed (F = 23.019, p <0.0001). In the eyes open and closed conditions were notedsignificant values (p <0.0001) for tandem and single leg. There was a significant increase for the MG for the contact area to plant both feet (F = 7.577, p = 0.001) and right foot (F = 5.332, p = 0.011), the maintenance time of challenging postures showed significant results in post time (p <0.05) in MG for accommodating tandem closed eye and the two-leg conditions; already for the D6 postures tandem rigid eye closed and one-leg open eye were significant. The data normalized myoelectric activity were not statistically significant. The results of this study showed beneficial effects of myofascial mobilization maneuver plant for all variables, except for the activation of the upper trapezius muscle after application of mobilization protocols.
Maintaining upright posture reveals an inherent to the human behavior, of postural sway. This continuous oscillation, provides input from the plantar area, for activating the central nervous system, resulting in adjustments to maintain posture in balance. The increase in muscle activation is an important strategy to address instability, and the upper trapezius muscle (UT) an important reference for postural control. In the elderly the position of maintenance strategies are compromised, which increases the risk of falls and compromises functional mobility. Thus, it is understood that the quality of support plant can help the elderly population in the maintaining of posture and less need for muscle activation. The aim of this study was to investigate the effect of maneuver planting myofascial mobilization the feet support area, as well as the involvement of variations of feet support in standing position at the time of maintenance of posture, balance, functional mobility, activation the upper trapezius muscle older. Were recruited for screening, 28 healthy older, with 69.03 ± 3.32 years, and randomly divided into two groups: Maneuver (MG) with 15 elderly and Sham (SG) with 13 elderly. The protocol was applied by the same appraiser, bilaterally, with 5 repetitions, divided into two weeks. For MG was conducted landslides plant with vigorous pressure from the hands of the researcher in order to reach the intrinsic muscles of the foot. In SG, the maneuver was carried out smoothly, aided by massage oil to encourage the slip on the skin. The data analysis took place in three different moments: the moment before the first maneuver (pre), immediately after (post) and on the last day of collection (D6). The results were divided into two studies. The study1 examined area of assessment data and plantar arch, plantar arch index, downtime in single leg stance with eyes open (SLSeo) and closed (SLSec) and functional mobility test - Timed Up and Go (TUG). Study 2 analyzed assessment data as plantar area, and downtime in the most challenging postures, electromyographic activation of the UT muscle in pre intervention time, in support of changes to plant and after mobilization protocol. In Study 1 there were significant increases in the conditions after the intervention only for the MG to contact plantar area of both feet (F = 7.577, p = 0.001) in the TUG (F = 15.099, p <0.001) in SLSeo (F = 14.592, p <0.0001) and SLSec (F = 3.398, p = 0.048) showing the beneficial effect of plant myofascial mobilization technique for increasing the contact area, balance and functional mobility. In study 2 showed an increase in electromyographic activity with reduced support base to open eyes (F = 7.456; p = 0.0002) and closed (F = 23.019, p <0.0001). In the eyes open and closed conditions were notedsignificant values (p <0.0001) for tandem and single leg. There was a significant increase for the MG for the contact area to plant both feet (F = 7.577, p = 0.001) and right foot (F = 5.332, p = 0.011), the maintenance time of challenging postures showed significant results in post time (p <0.05) in MG for accommodating tandem closed eye and the two-leg conditions; already for the D6 postures tandem rigid eye closed and one-leg open eye were significant. The data normalized myoelectric activity were not statistically significant. The results of this study showed beneficial effects of myofascial mobilization maneuver plant for all variables, except for the activation of the upper trapezius muscle after application of mobilization protocols.
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Palavras-chave
Pé, Idoso, Eletromiografia, Controle postural, Manipulação musculoesquelética, Foot, Elderly, Postural control, Musculoskeletal manipulation, Electromyography