Efeitos do fortalecimento muscular do tríceps sural na função da bomba venosa na insuficiência venosa crônica

Abstract

Resumo Contexto A insuficiência venosa crônica (IVC) é uma doença comum, uma disfunção da bomba muscular da panturrilha que repercute na hemodinâmica das estruturas. Objetivos Analisar os efeitos dos exercícios de fortalecimento muscular da panturrilha na hemodinâmica venosa em pacientes com IVC. Métodos O estudo contou com a participação de 13 pacientes e 25 membros inferiores com IVC, classificados entre C1 e C5 da classificação Clínica, Etiologia, Anatomia e Fisiopatologia (CEAP), oriundos do ambulatório de cirurgia vascular do Hospital Universitário Regional dos Campos Gerais. As variáveis analisadas foram dinamometria isométrica, goniometria, perimetria, adipometria no início, primeiro mês, segundo mês e final da aplicação do protocolo de exercícios. Resultados Os valores da dorsiflexão e da plantiflexão aumentaram 5º (p < 0,001). Na adipometria notou-se uma redução de 5 mm (p < 0,001). Quando separados em grupos pela CEAP, na C2 houve aumento de 5º na dorsiflexão (p = 0,02) e na plantiflexão (p < 0,001); na C3 houve aumento de 5º na dorsiflexão (p = 0,003) e redução de 1 mm na adipometria (p < 0,004); na C1 houve aumento da perimetria de 1,2 cm (p = 0,04). Conclusões A aplicação de protocolos de exercícios deveria ser considerada como uma forma de tratamento para IVC, pois impacta positivamente em fatores de risco e nas funções que estão deterioradas pela patologia.

Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery

“…88,89 Physical exercise protocols have shown improvement in range of motion of the tibiotarsal joint and should be considered for treatment of CVI. 90 Increased muscle strength was found to impact the venous pump, improving its function and the range of motion of the ankle. In addition, pain decreased and quality of life improved after adopting the exercise program.…”

“…• We recommend physical exercise to treat chronic venous insufficiency at any stage. o Level B o Class I o References: [90][91][92][93][94][95][96][97] Recommendation 13…”

The relationship between inspiratory muscle strength, venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency

“…4,5 The pathophysiology of CVI is complicated by the functional impairment of the muscle pump caused by decreased muscle strength, and therefore, when the severity of venous insufficiency increases, impaired strength of calf muscles becomes more evident and in addition the relationship between strength of the calf muscles and VRT has been demonstrated in patients with CVI. 6–8…”

“…4,5 The pathophysiology of CVI is complicated by the functional impairment of the muscle pump caused by decreased muscle strength, and therefore, when the severity of venous insufficiency increases, impaired strength of calf muscles becomes more evident and in addition the relationship between strength of the calf muscles and VRT has been demonstrated in patients with CVI. [6][7][8] Muscle pump dysfunction does not just affect the calf muscles; it also affects the diaphragm which is the main inspiratory muscle, which provides a suction effect on the inferior vena cava during expiration and during expiration that the diaphragm can affect augmented flow in the lower extremities. The inferior vena cava passes through the 1 Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Firat University, Elazig, Turkey 2 Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey diaphragm, so the diaphragm helps to direct blood from the legs to the heart.…”