Fisioterapia vascular no tratamento da doença venosa crônica

Abstract

Background: In chronic venous disease (CVD), vascular physiotherapy in the form of therapeutic exercises and manual lymph drainage (MLD) contributes to reducing vascular disorders, with improved venous return, reduced venous stasis and improved clinical status. Objective: To investigate the efficacy of vascular physiotherapy in treatment of CVD. Methods: A prospective, longitudinal pilot study that assessed ten patients with CVD, with CEAP classifications from 1 to 5. Patients were administered the SF-36 and AVVQ quality of life questionnaires and underwent water plethysmography and goniometry of the lower limbs. After initial assessments they were given ten 60-minute sessions of vascular physiotherapy consisting of therapeutic exercises and MLD. After treatment they were once more assessed using the same questionnaires and methods for volumetric measurement and assessment of joint movement amplitude (JMA). Results: The patients were all female, with a mean age of 43.1 years. Their predominant positions during practical activities of life was prolonged and orthostatic. The majority of the patients had a CEAP classification of C 3 and just 10% were C 2 . When questioned about their principal complaints, they reported feelings of heaviness and tiredness in their limbs, pain in their legs, itching and swelling. After the vascular physiotherapy sessions all patients were free from complaints. Both JMA and quality of life improved significantly after the intervention with vascular physiotherapy. Conclusions: Vascular physiotherapy contributed to controlling the clinical manifestations of CVD, improving edema and JMA, and promoting improved quality of life for patients.

Mobilidade da articulação talocrural como fator preditor no prognóstico de cicatrização em portadores de insuficiência venosa crônica com úlcera venosa

“…Limbs classified into groups by amplitude of ankle joint movement, against the outcomes healed ulcer (C5), active ulcer (C6) or no ulcer. Ankle joint immobility can suppress calf muscle pump activity and is one of the causes of untreatability among patients with venous ulcers, 15 because, when walking, the deep layer of the crural fascia triggers contraction of the triceps-surae, which only functions adequately if amplitude is preserved. 16 The association between reduced ankle joint mobility and venous ulcers was described for the first time in 1931.…”

Vascular physiotherapy: a strategy for treatment of chronic venous disease

“…In conclusion, the vascular physiotherapy protocol for treatment of chronic venous disease conducted by Leal et al 1 achieved important results and could be enhanced with compression garments. The protocol with resistance and aerobic exercises could have been explained in greater detail in order that it could be reproduced by other health professionals.…”

“…4 These recommendations apply to most patients in most circumstances without reservations. 3,4 It is clear that the results of the treatment protocol applied by Leal et al 1 were good, but they could have been enhanced by addition of elastic compression stockings or nonelastic bandages worn during the exercise protocol and afterwards. 5 Treatment with 30 to 40 mm Hg compression stockings results in significant improvement in pain, swelling, skin pigmentation, activity, and well-being if compliance of 70% to 80% is achieved.…”

“…We read with great interest the recent manuscript by Leal et al 1 entitled "Vascular physiotherapy in treatment of chronic venous disease". The authors investigate the results of a supervised rehabilitation protocol including warm-up, training and relaxation.…”

“…Structured exercise improves calf muscle pump function in chronic venous insufficiency and the efficacy of physical conditioning has been convincingly demonstrated in patients with chronic venous disease, but none of the practice guidelines for treatment of chronic venous disease describe the aerobic or strength training used in detail. [5][6][7] Perhaps this is the reason Leal et al 1 did not provide details of the aerobic and resistance exercises prescribed. If the objective of physical treatment is to improve calf muscle pump function, we suggest following the American College of Sports Medicine's guidelines for exercise prescription.…”