Apresentação do PowerPoint...Br J Sports Med. 342-350 • Pollock et al. (2014) British athletics...
Transcript of Apresentação do PowerPoint...Br J Sports Med. 342-350 • Pollock et al. (2014) British athletics...
Lesões Musculares Considerações para a Redução do Risco e Reabilitação
João NouraFisioterapeuta Coordenador da Unidade de Fisioterapia Desportiva e Performance CMM/Peak
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Índice
✓ Lesão Muscular
✓ Definição
✓ Etiologia e Mecanismos de Lesão
✓ Complicações mais comuns
✓ Epidemiologia
✓ Fatores de Risco
✓ Redução de Risco de Lesão
✓ Avaliação Clínica
✓ Subjetiva e Física
✓ Abordagem Biopsicossocial
✓ Imagiologia
✓ Reabilitação
✓ Fases, estratégias e Return-to-Play
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Zadro et al. (2020) High‐ and low‐value care in sport and exercise medicine: areas for consideration. Translational Sports Medicine.
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Lesão Muscular - Definição
• Fuller et al. (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports. 83-92
• Mueller-Wohlfahrt et al. (2013) Terminology and classification of muscle injuries in sport: The Munich consensus statement. Br J Sports Med. 342-350
• Pollock et al. (2014) British athletics muscle injury classification: a new grading system. Br J Sports Med. 1-6
• Valle et al. (2016) Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application. Sports Med. 1241 - 1253
• Definição de lesão muscular [adaptada de Fuller et al. (2006)]:
✓ Qualquer queixa física de etiologia muscular descrita por um jogador e que resulte de um jogo ou treino de futebol,
independentemente de necessitar ou não de atenção clínica ou de perder ou não de tempo de participação.
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Lesão Muscular - Etiologia
• Ueblacker (2015) Epidemiological and clinical outcome comparison of indirect (‘strain’) versus direct (‘contusion’) anterior and posterior thigh muscle injuries in male elite football players:
UEFA Elite League study of 2287 thigh injuries (2001–2013). Br J Sports Med. 1461–1465
• Lesão por mecanismo diretoo Lesão traumática causada por um trauma externo direto
• Lesão por mecanismo indiretoo Lesão muscular sem a existência de um trauma externo direto
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Mecanismo de Lesão
• Liu , Garrett, Moorman, Yu (2012) Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: A review of the literature. Journal of Sport and Health Science.
92 -101
• Mendiguchia et al. (2012) Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med
• Serner et al (2016) Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?. Br J Sports Med. 1541–1547
• Armfield et al. (2006) Sports-Related Muscle Injury in the Lower Extremity. Clinics In Sports Medicine. 803–842
Isquio-tibiais Quadricípite Adutores Trícipite Sural
✓ Remate
✓ Aceleração/ Desaceleração frontais✓ Aceleração/Desaceleração laterais
✓ Passe/ Remate
✓ Mudança de direção
✓ Aceleração/ Desaceleração frontais
✓ Sprint
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Complicações mais comuns
• Datir e Connell (2009) Muscle Injury and Complications. Essential Radiology for Sports Medicine . 199 – 215
• Brukner et al. (2016) ‘Serious thigh muscle strains’: beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains.
Br J Sports Med. 205 – 208
• Ueblacker et al. (2016) Treatment of muscle injuries in football. Journal of Sports Sciences. 2329–2337
• Trojian (2013) Muscle Contusion (Thigh). Clin Sports Med. 317 – 324
• Armfield et al. (2006) Sports-Related Muscle Injury in the Lower Extremity. Clinics In Sports Medicine. 803–842
• Localização
• Irá influenciar tempo e progressão da cicatrização e reabilitação
• Seroma
• Pequeno quisto que pode interferir com a normal cicatrização do tecido muscular
• Síndrome Compartimental
• Edema exacerbado após trauma ou lesão muscular
• Implica diminuição na perfusão e/ou perdas neuromusculares
• Gestão dependerá do local da lesão (mais/menos massa muscular)
• Miosite Ossificante
• Pequena tumefação palpável na localização da lesão muscular
• Pode resultar de intervenção exacerbada mobiliação de tecidos moles numa fase precoce
• Crescimento exponencialmente mais rápido que sarcoma
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Epidemiologia
• Jones et al. (2018) Epidemiology of Injury in English Professional Football Players: a cohort study. Physical Therapy in Sport
• Ekstrand, Hagglund, Waldén (2011) Epidemiology of Muscle Injuries in Professional Football (Soccer). The American Journal of Sports Medicine. 1226-1232
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Epidemiologia
• Ekstrand et al. (2019) Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study. Br J Sports Med. 1–6
Músculo Tipo de Lesão Frequência(% de todas as lesões)
Tempo de paragem(média em dias)
GastrocnémioFuncional 1,1 5,6
Estrutural 4,1 17,4
QuadricípiteFuncional 1,1 4,9
Estrutural 4,6 19,5
Isquio-tibiaisFuncional 3,6 5,9
Estrutural 13,8 18,0
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Epidemiologia
• Ekstrand et al. (2013) Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med
• Barnes et al. (2014) The Evolution of Physical and Technical Performance Parameters in the English Premier League. Int J Sports Med. 1095 -1100 via YLMSportsSciences https://ylmsportscience.com/
• Bahr et al. (2016) Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J
Sports Med. 1-7
• Bengtsson et al. (2013) Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 743–747
• Mccall et al. (2016) Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. Br J Sports Med. 725
- 730
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Epidemiologia
• Ekstrand et al. (2013) Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med
• Barnes et al. (2014) The Evolution of Physical and Technical Performance Parameters in the English Premier League. Int J Sports Med. 1095 -1100 via YLMSportsSciences https://ylmsportscience.com/
• Bahr et al. (2016) Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J
Sports Med. 1-7
• Bengtsson et al. (2013) Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 743–747
• Mccall et al. (2016) Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams’ head medical officers. Br J Sports Med. 725
- 730
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Fatores de Risco
• Football Medicine em https://footballmedicine.net/abc-of-football-medicine-lesson-5-risk-factor-assessment/ de19 de Junho de 2019 e consultado em 25/04/2020
• Green et al. (2020) Recalibrating the risk of hamstring strain injury (HSI) - A 2020 systematic review and meta-analysis of risk factors for index and recurrent HSI in sport. Br J Sports
Med. 1–10
• Bittencourt et al. (2016) Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept. Br J Sports
Med. 1309 – 1314
• Mendiguchia et al. (2012) Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med
• Lesão Prévia
• Idade
• Gestão das Cargas
• Fadiga
• Fatores contextuais
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Ivarsson et al (2017) Psychological Predictors of Injury Occurrence: A Prospective Investigation of Professional Swedish Soccer Players. Journal of Sport Rehabilitation. 19–26
• Mann et al. (2015) Effect of Physical and Academic Stress on Illness and Injury in Division 1 College Football Players. The Journal of Strength & Conditioning. 20-25
• https://ylmsportscience.com/
Fatores de Risco
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Kolehmainen et al. (2014) Chronic Psychological Stress Impairs Recovery Of Muscular Function And Somatic Sensations Over A 96-hour Period. Journal Of Strength And Conditioning
Research. 2007–2017
Fatores de Risco
Atletas com maior exposição a stress a curto-prazo apresentavam, num espaço até 96 horas (D+4):• Menor recuperação da produção de força voluntária máxima a 48 horas
• Menor recuperação e perceção da energia
• Menor recuperação da disponibilidade física
• Menor redução e mais sensação de fadiga muscular
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Silva et a. (2019) Poor Sleep Quality’s Association With Soccer Injuries: Preliminary Data. International Journal of Sports Physiology and Performance. 671–676
• Ekstrand (2018) Is there a correlation between coaches’ leadership styles and injuries in elite football teams? A study of 36 elite teams in 17 countries. Br J Sports Med. 527-531
Fatores de Risco
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Fatores de Risco
• Suvarna et al. (2020) Health risk behaviours and allostatic load: A systematic review. Neuroscience and Biobehavioral Reviews. 694 - 711
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Redução do Risco
• Coles (2017) An injury prevention pyramid for elite sports teams. Br J Sports Med. 1-3
• Windt e Gabbett (2017) How do training and competition workloads relate to injury? The workload—injury aetiology mode. Br J Sports Med. 1–9
• Malone et al. (2017) High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football . Journal of Science and Medicine in Sport. 250–254
• Lauersen et al. (2018) Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta- analysis. Br J Sports Med. 1-8
• Yoo et al. (2010) A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 824–830
• Schuermans et al. (2017) Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?. Gait & Posture. 270-277
• Thorborg et al. (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 562-571
• Van Dyk et al. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. :1362–1370
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Avaliação Clínica
• Ishoi et al. (2020) Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish
Society of Sports Physical Therapy (DSSF). Br J Sports Med. 1-12
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Avaliação Clínica
• João Espregueira-Mendes et al. (2017) Injuries and Health Problems in Football - What Everyone Should Know. Springer.
• Ishoi et al. (2020) Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish
Society of Sports Physical Therapy (DSSF). Br J Sports Med. 1-12
• Serner et al (2016) Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?. Br J Sports Med. 1541–1547
• História Clínica • Avaliação Objetiva
➢ Lesões Prévias?
➢ Mecanismo de Lesão associado?
➢ Como? Quando?
➢ Picada?
➢ Conseguiu prosseguir ou teve de abandonar o jogo?
➢ Dias seguintes? Medicação?
➢ Palpação
➢ Extensão e magnitude da dor
➢ Amplitudes articulares
➢ Testes resistidos isométricos
➢ Não é necessário graduar
➢ Testar várias amplitudes
➢ Alongamento
➢ Outros testes
➢ Taking-off shoe
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Avaliação Clínica
• Fischerauer et al. (2018) What Is the Relationship of Fear Avoidance to Physical Function and Pain Intensity in Injured Athletes?. Clin Orthop Relat Res. 754-763
• O’Keefe et al. (2019) Fear-Avoidance Following Musculoskeletal Injury in Male Adolescent Gaelic Footballers. Journal of Sport Rehabilitation
“Quem se lesionou não foi um músculo; foi um atleta… Uma pessoa.”
✓ Objetivos a curto/médio/longo-prazo✓ Experiência passada com lesões✓ Experiência passada com reabilitações✓ Crenças relacionadas com a lesão✓ Crenças relacionadas com a dor✓ Expectativas do processo de reabilitação✓ Expectativas da Fisioterapia
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Imagiologia
• Zadro et al. (2020) High‐ and low‐value care in sport and exercise medicine: areas for consideration. Translational Sports Medicine
• Brukner et al. (2015) ‘Serious thigh muscle strains’: beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains. Br J
Sports Med. 205–208
• Reurink et al. (2015) Magnetic Resonance Imaging in Acute Hamstring Injury: Can We Provide a Return to Play Prognosis?. Sport Med. 133–146
História Clínica
Expectativa do
staff e do atleta
Procura de
resultados
Incidentalomas
Mau para estabelecer
prognóstico
• Quem é o atleta?
• O que aconteceu?
• De que suspeitamos?
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Dubois et al. (2019) Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med
• Bayer et al. (2017) Early versus Delayed Rehabilitation after Acute Muscle Injury. N Engl J Med. 1300-1301
• Hickey et al. (2019) Pain-free versus pain-threshold rehabilitation following acute hamstring strain injury: A randomised controlled trial. Journal of Orthopaedic & Sports Physical
Therapy
Reabilitação – Fase Aguda
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação – Abordagem geral
• Isokinetic: Periodised, individualised & mixed Methods NMT em https://www.isokinetic.com/en/
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Bourne et al. (2017) Impact of exercise selection on hamstring muscle Activation. Br J Sports Med. 1021–1028
• Mendez-Villanueva et al. (2016) MRI-Based Regional Muscle Use during Hamstring Strengthening Exercises in Elite Soccer Players. PLoS ONE. 1-15
Reabilitação – Exercícios Específicos Isquio-tibiais
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação – Exercícios Específicos Isquio-tibiais
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Strength and Conditioning Research de Chris Beardsley em https://www.strengthandconditioningresearch.com/
Reabilitação – Exercícios Específicos Quadricípite
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Serner et al. (2014) EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. Br J Sports Med. 1108-
1114
• Harøy et al. (2018) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 1-8
Reabilitação – Exercícios Específicos Adutores
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação – Exercícios Específicos Trícipite Sural
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Maestroni et al. (2019) Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance. Sports Med
• King et al. (2019) Want to improve return to sport outcomes following injury? Empower, engage, provide feedback and be transparent: 4 habits!. Br J Sports Med. .
Reabilitação - Geral
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação - Geral
“Quem se lesionou não foi um músculo; foi um atleta… Uma pessoa.”
Manutenção Sistemas Energéticos Outras qualidades de forçaTécnica de Movimento
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação – Influência das Dimensões Psicológicas
• Taylor et al. (1998) Pain Education and Management in the Rehabilitation from Sports Injury. The Sport Psychologist. 68-88
• Hsu et al. (2016) Fear of Reinjury in Athletes: Implications for Rehabilitation. Sports Health: A Multidisciplinary Approach
• Ivarsson et al. (2017) Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-
analysis. Open Access Journal of Sports Medicine. 27–32
• Fordsyke et al (2017) Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports
Med. 537–544
Fase Aguda Fase Intermédia Fase RtP
Psic
oló
gic
os
Con
textu
ais
So
cia
is
Resistência à Progressão
Coping Ativo
Autonomia
Expectativas
Suporte Social
Participação no Processo
Influências Ambientais
Cultura Desportiva
“Quem se lesionou não foi um músculo; foi um atleta… Uma pessoa.”
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação – Return-to-Play
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Vanrenterghem (2017) Training Load Monitoring in Team Sports: A Novel Framework Separating Physiological and Biomechanical Load-Adaptation Pathways. Sports Med.
Reabilitação – Return-to-Play
Sobrecarga Mecânica
Exposição gradual dos tecidos à tarefa
que causou lesão/ mais exigente.
Poderá causar fadiga muscular mas
não deverá causar fadiga sistémica.
Exemplo de exercício: Número de
passes ou remates; distância
percorrida; Número e distância de
sprints de alta intensidade; Número
de mudanças de direção,
acelerações e desacelerações;
Número de saltos.
Tempos de repouso prolongados.
Monitorizar DOMS, parâmetros
executados
Sobrecarga Metabólica
Exposição gradual e repetida do
organismo à tarefa que causou
lesão/ mais exigente.
Deverá causar fadiga sistémica
durante a sessão e hipoteticamente
fadiga muscular.
Exemplo de exercício: Número e
distância de sprints repetidos;
Número de mudanças de direção,
acelerações e desacelerações
repetidas.
Tempos de repouso curtos.
Monitorizar sRPE/ RPE/ FC
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Vanrenterghem (2017) Training Load Monitoring in Team Sports: A Novel Framework Separating Physiological and Biomechanical Load-Adaptation Pathways. Sports Med.
• Hegyi, Gonçalves, Finni, Cronin (2019) Individual Region- and Muscle-specific Hamstring Activity at Different Running Speeds. Medicine & Science in Sports & Exercise
Reabilitação – Return-to-Play, Isquiotibiais
Progressão:
1. Qualidade
2. Quantidade
10/15 metros Distância de Sprint
X segundos
10/15 metros Distância de Sprint
X - t segundos
10/15 metros Distância de Sprint + d
X segundos
10/15 metros
Distância de Sprint
X segundos
N vezes
10/15 metros 10/15 metros
Distância de Sprint + d
X - t segundos
N + k vezes
10/15 metros
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Reabilitação – Return-to-Play, Quadricípite, Adutores, Trícipite Sural
• Vanrenterghem (2017) Training Load Monitoring in Team Sports: A Novel Framework Separating Physiological and Biomechanical Load-Adaptation Pathways. Sports Med.
Distância
de Passe
Distância de Passe + d
Distância
de Passe
Aceleração /
Desaceleração
Utilização tendão >
Utilização Músculo
Utilização Músculo >
Utilização tendão
> Utilização Músculo= Utilização Músculo
> Nº de repetições/ tempo> Menor espaço para
mudança de direção
> Menor tempo para mesmo
número de mudanças
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
➢ Taberner; Allen; Cohen (2019) Progressing rehabilitation after injury: consider the ‘control-chaos continuum’. Br J Sports Med
Ambiente fechado/
Foco internoAmbiente aberto/
Foco na tarefa
Reabilitação – Return-to-Play
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
Critérios return-to-Play
• Hickey et al. (2016) Criteria for Progressing Rehabilitation and Determining Returnto- Play Clearance Following Hamstring Strain Injury: A Systematic Review. Sports Med
• Ardern et al. (2016) 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 1-12
O que é um Return-to-Play bem sucedido?✓ O mais rápido possível?
✓ Com a segurança mínima?
✓ Nas melhores condições possíveis?
+ Radiologista
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação
• Ardern et al. (2016) 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 1-12
• Bengtsson et al. (2019) Few training sessions between return to play and first match appearance are associated with an increased propensity for injury: a prospective cohort study of
male professional football players during 16 consecutive seasons. Br J Sports Med. 1-6
Return-to-Competition
Lesões Musculares – Considerações para a Redução do Risco e Reabilitação