Muscle injury: physiopathology, diagnostic, treatment and clinical presentation

O tecido muscular esquelético possui a maior massa do corpo humano, com 45% do peso total. As lesões musculares podem ser causadas por contusões, estiramentos ou lacerações. A atual classificação separa as lesões entre leve, moderada e grave. Os sinais e sintomas das lesões grau I são edema e desconforto; grau II, perda de função, gap e equimose eventual; grau III, rotura completa, dor intensa e hematoma extenso. O diagnóstico pode ser confirmado por: ultrassom - dinâmico, barato, porém examinador-dependente; tomografia ou ressonância magnética - maior definição anatômica, porém estático. A fase inicial do tratamento se resume ao protocolo PRICE. AINH, ultrassom terapêutico, fortalecimento e alongamento após a fase inicial e amplitudes de movimento sem dor são utilizados no tratamento clínico. Já o cirúrgico possui indicações precisas: drenagem do hematoma, reinserção e reforço musculotendíneos.Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides such injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by: ultrasound, which is dynamic and cheap, but examiner dependent; and tomography or magnetic resonance, which gives better anatomical definition, but is static. Initial phase of the treatment can be summarized as the "PRICE" protocol. NSAIDs, ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement

Tratamento por ondas de choque nas doenças musculoesqueléticas e consolidação óssea – Análise qualitativa da literatura

ResumoO tratamento por ondas de choque é uma opção na ortopedia. O mecanismo exato pelo qual funcionam as ondas de choque para tratar doenças musculoesqueléticas não é conhecido. O objetivo deste trabalho é fazer a análise qualitativa da efetividade do tratamento por ondas de choque em pacientes com patologias musculoesqueléticas e pseudoartroses. A pesquisa foi feita nas bases de dados Cochrane Library, Medline e Lilacs. Encontrou 39 estudos que relatam o tratamento por ondas de choque de doenças musculoesqueléticas. Os resultados são muito variados, assim como os tipos de protocolo. Os estudos que avaliaram a efetividade do tratamento por ondas de choque para epicondilite lateral, tendinopatias do ombro, osteoartrose do joelho, osteonecrose da cabeça do fêmur e bursite trocanteriana relataram resultados inconsistentes para a melhoria dos pacientes. Os que avaliaram pacientes com tendinopatia calcária, fascite plantar, tendinopatia do tendão calcâneo e patelar e pseudoartrose mostraram benefício. O tratamento por ondas de choque é um método seguro e não invasivo para os casos crônicos em que os convencionais não tenham sido satisfatórios e deve ser associado aos outros métodos de tratamento das tendinopatias. Novos estudos de qualidade são necessários.AbstractShockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty‐nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non‐invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed

The effect of physical training on locomotive apparatus in elderly people

Alterações fisiológicas que ocorrem no aparellho locomotor devido ao envelhecimento como perda de massa muscular, perda do equilíbrio corporal, diminuição da massa óssea e osteoartrose causam limitações às atividade da vida diária do idoso, comprometendo sua qualidade de vida e o tornando mais frágil e dependente. Idosos que realizam atividade física periodicamente tem melhor independência funcional e melhor qualidade de vida do que aquele sedentário. Esse artigo aborda as principais alterações fisiológica do processo de envelhecimento e realiza uma revisão da literatura atual sobre os efeitos que o exercício físico causa no aparelho locomotor do idoso, especificando qual a melhor forma de prescrever atividade física nessa faixa etária.Physiological changes taking place on the locomotive apparatus as a result of aging, such as muscular mass loss, body balance loss, reduced bone mass and osteoarthrosis cause limitations to the daily activities of elderly people, compromising their quality of life and making them weaker and dependent. Aged people who regularly practice physical activities have a higher level of functional independence and a better quality of life than the sedentary ones. This article addresses the key physiological changes with aging and provides a review of current literature about the effects of physical exercises on the locomotive apparatus of elderly individuals, specifying the best ways to prescribe physical exercises to this age group

Uso do gelo nas lesões traumáticas do esporte

The use of ice on traumatic injuries is a very useful therapeutic modality, mainly on muscleskeletal injuries. However, when used in an incorrect way, without knowledge of neuro-physiological, muscular and vascular phenomena, as well as about its different forms of application, it can cause unpleasant consequences, which can be irreversible. According to several writers, the use of crushed ice, contained in a plastic bag, seems to evidentiate greater efficiency, and the suggested period of application can vary from 15 to 20 minutes; after this period local vasodilatation will occur. Each application can be repeated after intervals of 20 minutes. This matter is an open field for new investigations, which need to be more elucidatingO uso do gelo nas afecções traumáticas é uma modalidade terapêutica utilíssima, particularmente nas lesões músculo-esqueléticas. Entretanto, se aplicado de forma incorreta, sem conhecimento dos fenômenos neuro-fisiológicos, musculares e vasculares, assim como das diferentes formas de aplicações, poderá também trazer conseqüências desagradáveis, muitas vezes irreversíveis. Segundo vários autores, o gelo picado, em saco plástico, parece evidenciar maior eficiência, e o tempo de aplicação aconselhável é de 15 a 20 minutos, após o que ocorrerá vasodilatação reflexa local. Cada aplicação pode ser repetida após 20 minutos de intervalo. Trata-se de um campo aberto para novas investigações, que devem por sua vez, ser mais esclarecedora

Peptide glutamine supplementation for tolerance of intermittent exercise in soccer players

OBJECTIVE: To investigate whether supplementation of carbohydrate together with peptide glutamine would increase exercise tolerance in soccer players. METHODS: Nine male soccer players (mean age: 18.4 ± 1.1 years; body mass: 69.2 ± 4.6 kg; height: 175.5 ± 7.3 cm; and maximum oxygen consumption of 57.7 ± 4.8 ml.kg-1.min-1) were evaluated. All of them underwent a cardiopulmonary exercise test and followed a protocol that simulated the movements of a soccer game in order to evaluate their tolerance to intermittent exercise. By means of a draw, either carbohydrate with peptide glutamine (CARBOGLUT: 50g of maltodextrin + 3.5g of peptide glutamine in 250 ml of water) or carbohydrate alone (CARBO: 50g of maltodextrin in 250 ml of water) was administered in order to investigate the enhancement of the soccer players' performances. The solution was given thirty minutes before beginning the test, which was performed twice with a one-week interval between tests. RESULTS: A great improvement in the time and distance covered was observed when the athletes consumed the CARBOGLUT mixture. Total distance covered was 12750 ± 4037m when using CARBO, and 15571 ± 4184m when using CARBOGLUT (p<0.01); total duration of tolerance was 73 ± 23 min when using CARBO and 88 ± 24 min when using CARBOGLUT (p<0.01). CONCLUSION: The CARBOGLUT mixture was more efficient in increasing the distance covered and the length of time for which intermittent exercise was tolerated. CARBOGLUT also reduced feelings of fatigue in the players compared with the use of the CARBO mixture alone

Peptide glutamine supplementation for tolerance of intermittent exercise in soccer players

OBJECTIVE: To investigate whether supplementation of carbohydrate together with peptide glutamine would increase exercise tolerance in soccer players. METHODS: Nine male soccer players (mean age: 18.4 ± 1.1 years; body mass: 69.2 ± 4.6 kg; height: 175.5 ± 7.3 cm; and maximum oxygen consumption of 57.7 ± 4.8 ml.kg-1.min-1) were evaluated. All of them underwent a cardiopulmonary exercise test and followed a protocol that simulated the movements of a soccer game in order to evaluate their tolerance to intermittent exercise. By means of a draw, either carbohydrate with peptide glutamine (CARBOGLUT: 50g of maltodextrin + 3.5g of peptide glutamine in 250 ml of water) or carbohydrate alone (CARBO: 50g of maltodextrin in 250 ml of water) was administered in order to investigate the enhancement of the soccer players' performances. The solution was given thirty minutes before beginning the test, which was performed twice with a one-week interval between tests. RESULTS: A great improvement in the time and distance covered was observed when the athletes consumed the CARBOGLUT mixture. Total distance covered was 12750 ± 4037m when using CARBO, and 15571 ± 4184m when using CARBOGLUT (

Maximal oxygen uptake of male professional soccer players, 2012-2015, at the end of four preseasons training

Purpose: We hypothesized that the aerobic capacity of soccer players was well developed and maintained during the competitive season and that a short rest period in the off-season would not be sufficient to significantly affect V̇O2max in these players. Methods: A total of 211 soccer athletes (age range, 17-34 years) being 71 professional juniors and 113 professional adults were compared with a control group of 27 non-professionals soccer players. All players performed cardiopulmonary exercise testing on a treadmill.Results: The results showed that a large number of soccer players had  V̇O2max levels incompatible with the status of professional athletes in this sport. The results between the players were: The player’s juniors presented average V̇O2max (56.2 mL.min-1.kg-1) significantly higher (P < 0.05) of that the professional players (53.3 mL.min-1.kg-1) and controls  (amateur, 50.4 mL.min-1.kg-1). However, a large number of the adult (67%) and juniors  (42%) professionals players presented values of V̇O2max near to the values covered for the control group.Conclusions:  The study verified a great number of soccer players, considered of the elite, with values below that it is recommended for players of this competitive level. It seems that preseason training was not enough to achieve compatible V̇O2max levels for most players

Validação da versão para a língua portuguesa do questionário de Medida Funcional para Amputados (Functional Measure for Amputees Questionnaire)

The aim of this study was to translate into Brazilian-Portuguese and culturally adapt the Functional Measure for Amputees Questionnaire (FMA), also testing its reliability and validity for assessing lower-limb amputees functional capacity. The FMA was translated, back-translated, evaluated by a multidisciplinary committee, and pre-tested. The final version was submitted to field test on a group made up of 44 subjects (39 men and 5 women) with transtibial (N= 27) and transfemoral (N=17) amputation level. The inter- and intra-examiner test showed high reliability; Kappa mean values were higher than 0.80; and in 25% of the items values reached 1.0, thus suggesting excellent examiner agreement. Question 2 (which determines the Locomotor Capabilities Index) internal consistency value found was 0.79, showing consistency as to mobility assessment. The FMA cultural adaptation was satisfactory; a few changes were needed, without altering the original structure or content. Results suggest that the FMA Brazilian-Portuguese version is a reliable instrument to measure functional outcomes of Brazilian lower limb amputees having undergone rehabilitation.O objetivo deste estudo foi traduzir e adaptar culturalmente o Functional Measure for Amputees Questionnaire (FMA) para a população brasileira e analisar sua validade e eficácia quando aplicado em pacientes amputados de membro inferior. O procedimento seguiu as etapas de tradução, retro-tradução, análise das versões português e inglês por um comitê multidisciplinar, e pré-teste. O questionário traduzido foi aplicado em 44 pacientes (39 homens e 5 mulheres) com amputação em nível transtibial (N=27) e transfemoral (N=17), com idade média de 47,5±17,2 anos. No estudo da confiabilidade, em média, os coeficientes Kappa foram superiores a 0,80; e 25% deles foram iguais a 1,0, indicando haver excelente concordância inter e intra-entrevistadores. Na análise da consistência interna, o valor do coeficiente para a questão sobre o Índice de Capacidade Locomotora foi igual a 0,79, demonstrando haver consistência no bloco de questões relacionadas à mobilidade. A adaptação transcultural foi satisfatória; algumas modificações foram necessárias, porém sem implicar mudança na estrutura ou no conteúdo do questionário original. Os resultados sugerem que a versão brasileira do FMA, MFA - questionário de Medida Funcional para Amputados pode ser um instrumento confiável para medir o resultado funcional de pacientes brasileiros reabilitados após amputação de membro inferior