Fisioterapia em pacientes com síndrome fêmoro-patelar: comparação de exercícios em cadeia cinética aberta e fechada

Abstract

Este estudo teve como objetivo comparar a eficácia do fortalecimento muscular na recuperação funcional da síndrome fêmoro-patelar (SFP). Foram selecionadas 20 mulheres com SFP divididas em dois grupos: o Grupo 1 (G1) realizou fortalecimento do músculo quadríceps femoral em cadeia cinética aberta (CCA) e o Grupo 2 (G2) em cadeia cinética fechada (CCF), durante oito semanas com freqüência de duas vezes semanais. Foi avaliada a dor, capacidade funcional, flexibilidade, encurtamento dos músculos isquiotibiais, ângulo Q e eletromiografia (EMG) dos músculos vasto medial (VM) e vasto lateral (VL) durante extensão isométrica da perna. Antes e após o tratamento, as variáveis foram analisadas pelo teste de Wilcoxon, e entre os grupos pelo teste t para amostras independentes ou Anova de Friedman ou Manova (a<0,05). Após o tratamento, os resultados mostram que houve melhora da capacidade funcional, encurtamento dos músculos isquiotibiais e flexibilidade. Porém, somente o G1 apresentou diminuição da intensidade da dor e aumento da atividade EMG do músculo VL, enquanto ambos não modificaram o ângulo Q. Os dados sugerem que os tratamentos baseados no fortalecimento do músculo quadríceps femoral possibilitaram melhoras importantes nos principais sinais e sintomas apresentados pelas pacientes, não havendo diferenças evidentes entre os realizados em CCA e CCF.

Activation level of vastus medialis muscle in different rehabilitation exercises

“…10 The contrast in results with the present study comparing OKC and CKC can be explained once those authors used the leg press instead of the vertical squat as well as dynamic exercises instead of isometric, hindering the direct comparison of both studies. In the study of Stensdotter et al, 23 however, the extension exercise at 30° and the leg press from 30° to 0° were used, and their results have shown a greater activation of the VM muscle in the 30° extension exercise, consonantly with the present study.…”

“…4,5 One of the reasons for the lateralization is the muscular imbalance between the Vastus Lateralis (VL), which should draw the patella lateralward, and the Vastus Medialis which should draw the patella medialward. 1,[6][7][8][9][10] During the knee extension, all portions of the quadriceps, rectus femoris, vastus intermedius, and vastus lateralis, except the vastus medialis, provide lateralization trends in the patella. 8 The fibers of the VM, however, stands at a medial inclination of 55° in relation to the femoral diaphysis drawing the patella medialward.…”

“…Two studies Cabral et al 10 and Stensdotter et al 23 compared the knee extension exercises with leg press exercises. The study of Cabral et al 10 used the knee extension exercise at 90° and 45° in the extensor chair, and leg press from 0° to 45°.…”

Influence of the treatment of the Kinesio-taping® technique on pain and functionality in patients with Patellofemoral Pain Syndrome

“…Its etiology has not yet been clearly established, and may be related to biomechanical alterations, specifically, the static and dynamic imbalance. In static changes, some authors point out abnormalities such as poor patellar alignment, increased Q angle, high or low patella, excessive pronation, lateral rotation of the tibia, femoral anteversion, valgus or varus knees, and shortening of the lateral retinaculum, hamstring muscles and iliotibial tract 3 . Precipitating static factors that are also highlighted are: trauma, overuse, osteochondral alteration, irritation of the synovial plica and ligament laxity.…”

Comparison of Exercise Open Kinetic Chain and Closed Kinetic Chain in The Rehabilitation of Patellofemoral Dysfunction: an Updated Revision

“…However, pain retro patella and the lateral face can also be diagnosed (4). These symptoms are caused by structural orbiomechani cal changes of the joint, which becomes exacerbated by activities such as going up and down stairs, sit for a prolonged period, squatting or kneeling (2,5,21), resulting in increased compressive forces in the joint patellofemoral (4,6). Other signs are also present as the patellar crepitus, swelling, and joint blockage (6).…”