Intervenções para LBP

Intervenções para LBP

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Education

Most guidelines suggest education and advice as a key intervention strategy[1][2][3][4][5][6][7].  The common message is that patients should be reassured that they do not have a serious disease, that they should stay as active as possible, progressively increase their activity levels and return to work as soon as possible.  This is particularly relevant for patients with acute back pain who are low risk of disbaility.

The NICE Guidelines[1] summarise many of the available guidelines and state the following:

  • Provide people with advice and information to promote self-management of their low back pain.
  • Offer educational advice that includes information on the nature of non-specific low back pain and encourages the person to be physically active and continue with normal activities as far as possible.
  • Include an educational component consistent with this guideline as part of other interventions, but do not offer stand-alone formal education programmes.
  • Take into account the person’s expectations and preferences when considering recommended treatments, but do not use their expectations and preferences to predict their response to treatments.
  • Advise people with low back pain that staying physically active is likely to be beneficial.
  • Advise people with low back pain to exercise.

The STarT Back Approach also has some advice for us when educating individuals with LBP:

Language and labels

  • Use functional explanations for pain (sprained back, non-serious back pain). Example: “Many people have back pain from time to time but it is rare for this to be caused by a specific problem. Mostly all that is needed is to get your back moving again and things will settle down.
  • ”Avoid “spondylitis, degeneration, crumbling” etc.
  • Can be more specific sometimes, for example sciatica, if this leads to specific management.
  • Avoid investigating in the first place unless it is specifically indicated. However if you do so be aware that the technical terms used in reports often alarm patients. Translate appropriately, examples: “normal for your age ”, “ the changes seen on your scan are like getting grey hair or wrinkles as you get older”

Dealing with distress

  • Suspend pre-judgment
  • Listen carefully / summarize points
  • Plan to address points
  • Care with language and labels
  • Be honest and realistic
  • Do not criticize the opinions of other clinicians who have seen the patient.
  • Provide information

Activity promotion

  • Activity promotion: beneficial, hurt doesn’t equal harm, minimise bed rest
  • Pacing: short, frequent bouts of activity rather than overdoing things and then regretting it the next day, rests between activity, do less than maximal capabilities and increase as tolerated.
  • Return to work as soon as possible, prolonged absence likely to lead to loss of employment. Use fit notes to support return to work and communicate suggestions to the employer. Help the patient negotiate an early return to work if at all possible.

Exercise Therapy

There is now relatively large consensus across the various guidelines that specific back exercises (as opposed to the advice to stay active, including for example walking, cycling) are not recommended for patients with acute low back pain[3].  There are now also more firm recommendations in favour of exercise therapy in patients with subacute and chronic low back pain[3] but there is no evidence that one form of exercise is superior to another[8].  

NICE Guidelines[1] recommend offering a structured exercise programme tailored to the person. Exercise programmes may include aerobic activity, movement instruction, muscle strengthening, postural control and& stretching.  They should comprise up to a maximum of eight sessions over a period of up to 12 weeks, a group supervised exercise programme in a group of up to 10 people or one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.

Delitto [4]et al suggest that clinicians should consider:

  • utilizing trunk coordination, strengthening, and endurance exercises to reduce low back pain and disability in patients with sub-acute and chronic low back pain with movement coordination impairments and in patients post lumbar microdiscectomy. 
  • utilizing repeated movements, exercises, or procedures to promote centralization to reduce symptoms in patients with acute low back pain with related (referred) lower extremity pain. Clinicians should consider using repeated exercises in a specific direction determined by treatment response to improve mobility and reduce symptoms in patients with acute, subacute, or chronic low back pain with mobility deficits. 
  • flexion exercises, combined with other interventions such as manual therapy, strengthening exercises, nerve mobilization procedures, and progressive walking, for reducing pain and disability in older patients with chronic low back pain with radiating pain.
  • utilizing lower-quarter nerve mobilization procedures to reduce pain and disability in patients with subacute and chronic low back pain and radiating pain.
  • moderate- to high-intensity exercise for patients with chronic low back pain without generalized pain
  • incorporating progressive, low-intensity, submaximal fitness and endurance activities into the pain management and health promotion strategies for patients with chronic low back pain with generalized pain.

Manual Therapy

Manual Therapy refers to spinal manipulation (a low-amplitude, high-velocity movement at the limit of joint range that takes the joint beyond the passive range of movement), spinal mobilisation (joint movement within the normal range of motion) and massage (manual manipulation or mobilisation of soft tissues).

The recommendations regarding spinal manipulation continue to show some variation and systematic reviews have demonstrated marginal treatment effects across heterogeneous groups of patients with low back pain[9][10]. In some guidelines manipulation is recommended, or presented as a therapeutic option, usually for short-term benefit, but others do not recommend it[3].  The reason for these differences is probably that the underlying evidence is not strong enough to result in similar recommendations regarding manipulation across all guidelines, leaving more room for interpretation.  There may also be local and political reasons involved.  Recent research has demonstrated that spinal manipulative therapy is effective for subgroups of patients and as a component of a comprehensive treatment plan, rather than in isolation[4]. Clinical prediction rules can be used to identify patients that will benefit form thrust manipulation[11][12][13][14].

The NICE guidelines recommend offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks in early management of non-specific LBP[1].  

Delitto et al[4] suggest that clinicians should consider utilising thrust manipulative procedures to reduce pain and disability in patients with mobility deficits and acute low back and back-related buttock or thigh pain.  Thrust manipulative and nonthrust mobilization procedures can also be used to improve spine and hip mobility and reduce pain and disability in patients with subacute and chronic low back and back-related lower extremity pain.

Traction

There is conflicting evidence for the efficacy of intermittent lumbar traction for patients with low back pain. There is preliminary evidence that a subgroup of patients with signs of nerve root compression along with peripheralization of symptoms or a positive crossed straight leg raise will benefit from intermittent lumbar traction in the prone position. There is moderate evidence that clinicians should not utilize intermittent or static lumbar traction for reducing symptoms in patients with acute or subacute, nonradicular low back pain or patients with chronic low back pain[4][15] and recent guidelines advise against traction as a treatment option[8].

Electrotherapy

Evidence for efficacy of most electrotherapy modalities in the managment of low back pain is weak or lacking[16][17].  Guidelines suggest that electrotherapy modalities (laser, interferrential, ultrasound, TENS) are not appropriate for non-specific low back pain[3][1]  Passive treatment modalities (for example bed rest, massage, ultrasound, electrotherapy, laser and traction) should be avoided as mono-therapy and not routinely be used, because they may increase the risk of illness behaviour and chronicity[18].

Cognitive Behavioural Therapy

Behavioral education, also known as cognitive behavioral theory, encompasses many aspects of patient education and counseling for patients with low back pain, including:

  • Activity pacing
  • Attention diversion
  • Cognitive restructuring
  • Goal setting
  • Graded exposure
  • Motivational enhancement therapy
  • Maintenance strategies
  • Problem-solving strategies

Henschke et al[19] in a recent Cochrane review, concluded there is moderate-quality evidence that operant therapy and behavioral therapy are more effective than waiting-list or usual care for short-term pain relief in patients with chronic low back pain, but no specific type of behavioral therapy is superior to another. In the intermediate to long term, there is no established difference between behavioral therapy and group exercise for management of pain or depressive symptoms in patients with chronic low back pain.

The NICE guidelines[1] suggest referral for a combined physical and psychological treatment programme that includes a cognitive behavioural approach and exercise, comprising around 100 hours over a maximum of 8 weeks, for people who have received at least one less intensive treatment and have high disability and/or significant psychological distress.

References

  1. ↑ 1.01.11.21.31.41.5 National Institute for Health and Care Excellence. ↑ Hill J, D Whitehurst, Lewis M, Bryan S, Dunn K, Foster N, Konstantinou, Main C, Mason E, Somerville S, Sowden G, Vohora K, Hay E. A randomised controlled trial and economic evaluation of stratified primary care management for low back pain compared with current best practice: The STarT Back trial.The Lancet, Volume 378, Issue 9802, Pages 1560 – 1571, 29 October 2011
  2. ↑ 3.03.13.23.33.4 Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. ↑ 4.04.14.24.34.4 Anthony Delitto, Steven Z. George, Linda Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Joseph J. Godges. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic and Sports Physical Therapy, 2012, 42(4)
  3. ↑ Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J 2018; 27: 60-75.
  4. ↑ Van Wambeke P, Desomer A, Ailliet L, et al. Summary: ↑ Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166: 514-530.
  5. ↑ 8.08.1 Almeida M, Saragiotto B, Richards B, Maher C. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust 2018; 208 (6): 272-275
  6. ↑ Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, hekelle PG. Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;CD000447.
  7. ↑ Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871-881
  8. ↑ Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine (Phila Pa 1976).
  9. ↑ Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141:920-928.
  10. ↑ Cleland JA, Fritz JM, Kulig K, et al. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. Spine (Phila Pa 1976).
  11. ↑ Hancock MJ, Maher CG, Latimer J, Herbert RD, McAuley JH. Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial. Eur Spine J. 2008;17:936-943.
  12. ↑ Delitto A, Erhard RE, Bowling RW. ↑ Matthew S Thiese, Matthew Hughes and Jeremy Biggs. Electrical stimulation for chronic non-specific lowfckLRback pain in a working-age population: a 12-weekfckLRdouble blinded randomized controlled trial. BMC Musculoskeletal Disorders 2013, 14:117
  13. ↑ GE Bekkering, HJM Hendriks, BW Koes, RAB Oostendorp, RWJG Ostelo, JMC Thomassen, MW van Tulder. ↑ van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3. ↑ Henschke N, Ostelo RW, van Tulder MW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;CD002014

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Síndrome do nervo interósseo posterior

Síndrome do nervo interósseo posterior

by with No Comment Uncategorized

Definition/Description

Posterior interosseous nerve syndrome is a neuropathic compression of the posterior interosseous nerve where it passes through the radial tunnel.[1] This may result in paresis or paralysis of the digital and thumb extensor muscles, resulting in an inability to extend the thumb and fingers at their metacarpophalangeal joints. The only movement patients may be able to do is the dorsoradial direction.[2]

Radial nerve.jpg

Clinically relevant anatomy

The posterior interosseous nerve is located close to shaft of the humerus and the elbow. This nerve is the deep motor branch of the radial nerve. Proximal to the supinator arch, the radial nerve is divided into a superficial branch and posterior interosseous branch.The radial nerve supplies the majority of the forearm and hand extensors. Damage to this branch of the radial nerve results in posterior interosseous nerve syndrome.

The radial tunnel is a space that extends 5cm from the radial head to the distal margin of the supinator. This tunnel is attached laterally to the brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis and medially to the biceps tendon and brachialis. The floor is formed by the deep head of the supinator and the capsule of the radiocapitellar joint, while the roof is formed by the superficial head of the supinator and the radial recurrent vessels.[3]

At the level of the lateral epicondyle, between the brachioradialis and brachialis muscles, the radial nerve, which has its origin in the brachial plexus, divides into its 2 terminal branches: the superficial radial nerve and the posterior interosseous nerve.[4] The superficial radial nerve ends proximal to the radial tunnel. The posterior interosseous nerve is much longer and enters the radial tunnel underneath a musculotendinous arch, the arcade of Frohse. The arcade of Frohse, which is the most common point of compression, is a connection between the deep and superficial heads of the supinator and is fibrotendinous in 30% of the population. The posterior interosseous nerve continues in the radial tunnel through the supinator, as it goes from the anterior to the posterior surface of the forearm.

The posterior interosseous nerve is a motor nerve and sequentially innervates supinator, extensor carpi radialis brevis, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis, extensor pollicis brevis, extensor pollicis longus, and extensor indicis.[3][5]

Epidemiology/Etiology

Epidemiology

Posterior interosseous nerve syndrome is more common in males, manual laborours and bodybuilders, with an incidence of 3 per 100 000.[6] With a humeral shaft fracture, there is a 12% chance of associated with radial nerve paralysis.[7]

Etiology

Posterior interosseous nerve syndrome can be caused by a traumatic injury, tumors, inflammation and an anatomic injury. With repeated pronation and supination a dynamic compression of the nerve in the proximal part of the forearm can be created.[8]

Posterior interosseous nerve syndrome usually develops spontaneously[1] and is caused by compression injuries to the upper extremity, mostly in the arcade of Frohse[9]. It is the area where the nerve enters the supinator muscle[10] and is the most common place for a compression of the nerve. However, it can also occur following trauma, such as a blow to the proximal dorsal region of the forearm. Impingement of the radial nerve results in posterior interosseous nerve syndrome.[7] Compression of the posterior interosseous nerve is associated with repetitive activities that involve wrist supination and pronation, with a component of wrist extension.[11]

Posterior interosseous nerve syndrome can be iatrogenic following reduction of radial fracture, transposition of the ulnar nerve or release of the extensor origin for lateral epicondylitis.[1] The causes of posterior interosseous nerve syndrome include intrinsic nerve abnormalities and extrinsic compression.[2]

Characteristics/Clinical presentation

Most nerve entrapments occurs due to an osseoligamentous tunnel narrowing. In the case of a posterior interosseous nerve entrapment, the compression occurs within the musculo-tendinous radial tunnel. In 69.4%, the nerve is compressed by the fibrous arcade of Frohse.[12]

There is a very slow development of the symptoms. The duration of symptoms averaged 2-3 years before a definitive diagnosis could be made.[8] Symptoms of nerve entrapment syndromes are generally involving pain, sensory and motor changes, sensations of popping, paresthesias, and paresis.

Posterior interosseous nerve syndrome is characterized by motor deficits in the distribution of the posterior interosseous nerve.[12] While the posterior interosseous nerve does have afferent fibres that transmit pain signals from the wrist, it does not carry any cutaneous sensory information that can help distinguish a posterior interosseous nerve palsy from Differential diagnosis

Posterior interosseous nerve syndrome is one of the pathologies that can cause lateral elbow pain. The other pathologies that are associated with lateral elbow pain are:

  • [1]
  • Lateral epicondylitis[4]
  • Radial nerve injury/palsy[4]
  • Cervical radiculopathy[4]
  • Extensor carpi radialis brevis tendinosis[5]
  • Cervical spine C5-C7[5]
  • Extensor tendon rupture[13]
  • [14]
  • Supinator syndrome[14]
  • Brachialis neuritis[14]
  • Artirits/artrose of the radiohumeral joint
  • Meniscus of the radiohumeral joint
  • [13]

Diagnostic procedures

Careful clinical and electrophysiological examination is important and essential for a reliable diagnosis.[10]

Physical examination

  • History
  • Functional limitations or deficits
  • Palpation: Abnormal tenderness is expected over the arcade of Frohse and eventually over the lateral epicondyle
  • Neural tension test
  • Muscle testing (with resistance):[3][15] There a partial or complete paralysis of the wrist extensors:
    • The patient is unable to extend the thumb and other fingers of the affected side at the metacarpophalangeal joints
    • Wrist extension is possible, but only with a dorso-radial direction, due to the weakened extensor carpi ulnaris
    • Resisted supination and pronation of the forearm can produce pain, as well as resisted extension of the middle finger
    • The brachioradialis, extensor carpi radialis longus and extensor capri radialis brevis are innervated by more proximal branches of the radial nerve, so may be spared

Special investigations

The following special investigations are used to assist in making the diagnosis.[1] It further aids to establish the topography of the lesion and the severity of the muscular denervation.[10]

  • Electromyography: Identify level of compression
  • Nerve conduction velocity
  • MRI: Not commonly used:
    • To determine specific area of compression
    • Assist in surgical planning

Outcome measures

Medical management

There are several medical ways to treat the posterior interosseous nerve syndrome.

Conservative management

  • Reduction of local inflammation and swelling around the nerve:[16]
    • Wrist and/or elbow splints
      • The arm can be put in an above-elbow cast for ten days with the elbow flexed at 90°, the forearm supinated and the wrist in neutral position[17]
    • NSAID’s
    • Activity modification to reduce local inflammation and swelling around the nerve
  • Corticosteroid injections[17]
  • Therapeutic ultrasound[17]
  • Physiotherapy[17]
  • Reduction of synovitis:[18]
    • Heat
    • Rest
    • Mild range of motion

Surgery

  • Indication:
    • No improvement with conservative management
    • Pain present after 12 weeks
  • Aim: To obtain full recovery
  • Surgery: Depends on how and where impingement is present[18][19]
    • Arcade of Frohse release
    • Resection of lesions
    • Posterior interosseous nerve release

Physiotherapy management

Conservative management

3-6 months of physiotherapy with regular re-assessment of signs and symptoms is recommended. If there is no response to therapy, evidence of denervation, or persistent paralysis, surgical decompression should be considered.[12]

Physiotherapy should include a multimodal approach. The following can be considered based on the patient presentation:

  • Cryotherapy: Increase extensibility and reduce tone of local muscles
  • Ultrasound
  • TENS
  • Deep tissue massage and stretching exercises: Improve extensibility of the muscles who surround the brachial plexus and radial nerve
  • Dry needling: Increase extensibility and reduce tone of local muscles
  • Neural mobilizations:[20]
    • Reduce mechanical extra and intra-neural adhesion
    • Assist the neuromodulation of symptoms
  • Manual therapy[7]: Regain elbow mobility
  • Strengthening[12] and range of motion exercises
  • Stretching exercises:
    • Focus on supinator
    • Passive wrist extensions stretches:
      • Place hand on table and move upper body over wrist
      • Prayer stretch

Post-surgical rehabilitation

  • Commence active range of motion from day 3-5
    • Incorporate stretching of extensors
  • Commence strengthening from week 3-4

Patients can return to light duty work between week 2 and 3 post-operatively, while return to baseline function can take between 6 and 12 weeks.

[21]

Clinical bottom line

The posterior interosseous nerve is the deep branch stemming off the radial nerve. Compression can be caused by trauma, repetitive strain and inflammation. This is then known as posterior interosseous nerve syndrome, which may result in paresis or paralysis of the digital and thumb extensor muscles, resulting in an inability to extend the thumb and fingers at their metacarpophalangeal joints. Conservative management includes splinting, NSAID’s and physiotherapy, and symptoms normally resolve within 3-6 months. Failed conservative management is an indication for surgery, where nerve releases are the most common surgical intervention. Physiotherapy also plays a big part in the post-operative management, and rehabilitation generally lasts between 6 and 12 weeks.

References

  1. ↑ 1.01.11.21.31.4 Vrieling C, Robinson PH, Geertzen JH. ↑ 2.02.1 Chien AJ, Jamadar DA, Jacobson JA, Hayes CW, Louis DS. ↑ 3.03.13.2 Cha J, York B, Tawfik J. Posterior interosseous nerve compression. Eplasty 2014;14.
  2. ↑ 4.04.14.24.3 Bevelaqua AC, Hayter CL, Feinberg JH, Rodeo SA. ↑ 5.05.15.2 Ekstrom RA, Holden K. ↑ Ortho Bullets. PIN Compression Syndrome. Available from: ↑ 7.07.17.2 Quignon R, Marteau E, Penaud A, Corcia P, Laulan J. ↑ 8.08.1 Molina AP, Bour C, Oberlin C, Nzeusseu A, Vanwijck R. ↑ Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. ↑ 10.010.110.2 Huisstede BM, Miedema HS, Van Opstal T, De Ronde MT, Kuiper JI, Verhaar JA, Koes BW. ↑ Rosenbaum R. Disputed radial tunnel syndrome. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine 1999;22(7):960-7.
  3. ↑ 12.012.112.212.3 Saratsiotis J, Myriokefalitakis E. ↑ 13.013.1 Millender LH, Nalebuff EA, Holdsworth DE. ↑ 14.014.114.2 Kaswan S, Deigni O, Tadisina KK, Totten M, Kraemer BA. Radial tunnel syndrome complicated by lateral epicondylitis in a middle-aged female. Eplasty 2014;14.
  4. ↑ Singh VA, Michael RE, Dinh DB, Bloom S, Cooper M. ↑ Mansuripur PK, Deren ME, Kamal RO. ↑ 17.017.117.217.3 Maffulli N, Maffulli F. ↑ 18.018.1 Chang LW, Gowans JD, Granger CV, Millender LH. ↑ Hashizume H, Nishida K, Nanba Y, Shigeyama Y, Inoue H, Morito Y. ↑ 20.020.1 Molloy J, Neville V, Woods I, Speedy D. ↑ The Student Physical Therapist. Posterior interosseous nerve syndrome. Available from:

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Eletroterapia em tratamentos de fisioterapia

Eletroterapia em tratamentos de fisioterapia

by with No Comment Uncategorized

 Antecedentes Eletroterapia

 Você pode recordar a sensação de que o choque repentino ou talvez o sentimento após de alfinetes e agulhas? … Bem escalá-lo para baixo um pouco e não é completamente diferente de um tipo de tratamento disponíveis a Eletroterapia pode ser utilizada no controle da dor e promover a cicatrização do tecido, e acredite ou não, tem sido em utilizado a algum tempo …
Eletroterapia Estetica

A estimulação elétrica para controle da dor foi utilizada na antiga Roma, 63 dC Foi relatado por Scribonius Largus que a dor foi aliviada por estar sobre um peixe elétrico na beira do mar. De 16 a 18 séculos vários dispositivos eletrostáticos foram utilizados para dores de cabeça e outras dores, mesmo Benjamin Franklin era um defensor deste método para alívio da dor.

Eletroterapia utiliza sinais elétricos para interferir com a transmissão de sinais neurais de dor para o cérebro. Ele efetivamente retarda ou distrai a mensagem do nervo para o cérebro. De um ponto de vista de fisioterapia, afetando sua ‘dor Gate’, seja em um episódio de dor aguda ou crônica, é a área crucial do tratamento e eletroterapia é um recurso muito útil, onde os medicamentos convencionais não são tão afetiva. Eletroterapia, também pode envolver a utilização desta corrente eléctrica para acelerar a cura do tecido em que o dano dos tecidos, também ocorreu.

SAIBA MAIS

Curso de Eletroterapia na Ortopedia

Curso de Eletroterapia na Estética

Estimulação Elétrica Nervosa Transcutânea (TENS)

TENS é amplamente utilizado em todo o mundo para uma variedade de condições dolorosas, tais como;

  • Artrite
  • dor lombar
  • dor do Trabalho
  • nevralgias, tais como a dor fantasma

Como Funciona?

Um pequeno dispositivo elétrico. Fornece impulsos elétricos através da pele, versões mais leves não muito maior do que um cartão de crédito estão disponíveis estes dias. Isso pode ser cortada para o seu jeans ou colocado em seu bolso.

O dispositivo está ligado por fios aos elétrodos almofada pegajosa, que são colocados sobre a pele na área da dor. Isso permite que uma pequena carga eléctrica de baixa intensidade para ser passada através da área.

TENS Pode Funcionar De Duas Maneiras:

Eletroterapia Estetica

1 / On uma alta frequência, estimulando seletivamente certas fibras nervosas ‘não-dor “para enviar sinais para o cérebro que bloquear outros sinais nervosos que transportam mensagens de dor estimulação de alta frequência, às vezes chamado de “convencional”, é tolerável por horas, mas o alívio da dor resultante dura por um curto período de tempo.

2 / As freqüências mais baixas estimulam a produção de endorfinas, hormônios naturais para aliviar a dor – o seu próprio sistema interno de gestão da dor estimulação de baixa frequência, às vezes chamado de “acupuntura-like”, é mais desconfortável e tolerável para cerca de 20-30 minutos, mas o alívio da dor resultante dura mais tempo.

Ao contrário de muitos medicamentos para aliviar a dor, TENS não é viciante e tem poucos efeitos colaterais. A maioria das pessoas pode utilizar uma máquina de TENS, mas é inadequada para:

– Os Pacientes com marcapassos e alguns outros tipos de doenças cardíacas.

Causas

-Desconhecido de dor.

Locais do corpo

-Certos na gravidez (excepto em trabalho de parto)

-Certas doenças da pele

Usuários de TENS deve experimentar com diferentes posicionamentos dos eletrodos. Os elétrodos podem ser colocados sobre a área dolorosa, em torno da área dolorosa, sobre o nervo fornecendo a área dolorosa, ou mesmo no lado oposto do corpo usuários de TENS precisa experimentar a unidade durante vários dias com várias colocações de eletrodos antes de decidir se ele vai ser útil. Um ensaio casa por vários dias ou semanas é preferível.

Terapia Interferencial

É essencialmente uma forma mais profunda de TENS. Ele utiliza duas correntes de alta frequência que são um pouco fora de fase, e são passadas através da pele, ao mesmo tempo em que eles são configurados para que seus caminhos se cruzam e simplesmente interferem uns com os outros. Esta interferência dá lugar a uma frequência de batimento que tem as características de estimulação de baixa frequência debaixo da pele.

É administrada por um fisioterapeuta e envolve a colocação de esponjas molhadas no corpo, que fornecem uma corrente suave semelhante à sensação de alfinetes e agulhas. Manipulação da corrente permite que o fisioterapeuta para segmentar a estrutura correta e para tratar.

Existem 4 principais aplicações clínicas para as quais IFT foi encontrado para ser eficaz:

  • O alívio da dor (de um modo semelhante ao TENS)
  • estimulação muscular – evitar o desgaste muscular, reeducação, manter a amplitude de movimento
  • O aumento do fluxo sanguíneo local
  • Redução do edema

Estimular Tecidos Moles

Em situações agudas, os tempos de tratamento mais curtos, da ordem dos 5-10 minutos pode ser suficiente para alcançar o efeito. Em ouras  circunstâncias, pode ser necessário para estimular os tecidos durante 20-30 minutos. Sugere-se que os tempos de tratamento curtos são inicialmente especialmente com o caso agudo.

Eletroterapia é utilizado como um adjuvante para os tratamentos de fisioterapia tradicionais.

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Eletroterapia na Fisioterapia, Curso Eletroterapia

Eletroterapia na Fisioterapia, Curso Eletroterapia

by with No Comment Fisioterapia Traumato-Ortopédica

A eletroterapia na fisioterapia é uma área que utiliza correntes elétricas com finalidades terapêuticas, abrangendo recursos como ultrassom, laser, TENS, corrente interferencial e estimulação muscular. Esses recursos são aplicados para controle da dor, redução de edema, aceleração da cicatrização tecidual e fortalecimento muscular, sempre com base em evidências científicas e raciocínio clínico.

O que é eletroterapia na fisioterapia

A eletroterapia consiste na aplicação de energia elétrica ou eletromagnética para tratar disfunções musculoesqueléticas, neurológicas e tegumentares. Na prática clínica, o fisioterapeuta seleciona o recurso adequado conforme a fase da lesão, os objetivos do tratamento e as características do paciente. A formação continuada nessa área permite ao profissional atualizar-se sobre protocolos clínicos e evidências científicas, garantindo intervenções seguras e eficazes.

Principais recursos da eletroterapia

Os recursos eletroterapêuticos mais utilizados na fisioterapia incluem:

  • Ultrassom terapêutico: utilizado para tratamento de tecidos moles e fraturas, promovendo efeitos térmicos e mecânicos que auxiliam na regeneração tecidual.
  • Laserterapia: aplicada para modulação inflamatória, analgesia e reparo tecidual, com diferentes comprimentos de onda e dosagens.
  • Eletroanalgesia (TENS e IFC): a Estimulação Elétrica Nervosa Transcutânea (TENS) e a Corrente Interferencial (IFC) são amplamente empregadas no controle da dor aguda e crônica.
  • Estimulação muscular: correntes como a Russa e o FES (Functional Electrical Stimulation) são usadas para ganho de força, prevenção de atrofia e facilitação neuromuscular.
  • Treinamento muscular avançado: protocolos que combinam eletroestimulação com exercícios terapêuticos para otimizar o desempenho muscular.

Metodologia de aplicação clínica

A aplicação da eletroterapia exige conhecimento aprofundado sobre parâmetros de dosagem, posicionamento de eletrodos e contraindicações. A metodologia de ensino baseada em revisão de protocolos clínicos e artigos científicos, aliada à prática supervisionada, é fundamental para a capacitação profissional. Durante a formação, os participantes treinam todos os protocolos, incluindo técnicas de treinamento muscular avançado, o que favorece a tomada de decisão baseada em evidências.

Evidências científicas sobre correntes diadinâmicas

Um estudo experimental com ratos Wistar investigou os efeitos das Correntes Diadinâmicas de Bernard (CDB) sobre a nociceptividade e o edema em trauma tendíneo. Os animais foram divididos em grupo controle, grupo polo negativo e grupo polo positivo, e submetidos a trauma no tendão calcâneo com energia de 0,4 J. A nociceptividade foi avaliada por analgesímetro digital tipo Von Frey, e o edema por paquimetria. O tratamento consistiu em cinco sessões diárias com as correntes DF, CP e LP, aplicadas por três minutos cada. Os resultados mostraram que apenas o grupo tratado com o polo positivo apresentou redução significativa da nociceptividade e retorno do edema aos valores basais. Esses achados sugerem que a polaridade pode influenciar os efeitos terapêuticos das CDB, embora mais estudos sejam necessários para consolidar sua aplicação clínica.

Importância da atualização profissional em eletroterapia

A evolução constante das tecnologias e a publicação de novas pesquisas exigem que o fisioterapeuta mantenha-se atualizado. Cursos de capacitação oferecem a oportunidade de revisar protocolos, praticar técnicas e discutir casos clínicos, elevando a qualidade do atendimento. Curso Atualização em Eletrotermofototerapia

Objetivos da eletroterapia na reabilitação

Os principais objetivos da eletroterapia incluem o alívio da dor, a redução do processo inflamatório, a aceleração da cicatrização, o fortalecimento muscular e a melhora da função motora. A escolha do recurso deve considerar a fase da lesão (aguda, subaguda ou crônica), a profundidade do tecido-alvo e a resposta individual do paciente.

Aplicações gerais na prática fisioterapêutica

A eletroterapia é aplicada em diversas áreas da fisioterapia, como ortopedia, traumatologia, neurologia, dermatofuncional e esportiva. Em lesões musculoesqueléticas, por exemplo, o ultrassom e o laser são frequentemente utilizados na fase inicial para controle da inflamação, enquanto a estimulação elétrica é empregada nas fases posteriores para recuperação da força. Na fisioterapia esportiva, o treinamento muscular avançado com eletroestimulação pode ser integrado a programas de reabilitação e prevenção de lesões.

Conclusão

A eletroterapia é uma ferramenta valiosa na prática fisioterapêutica, desde que embasada em conhecimento científico e aplicada com critério. A formação continuada permite ao profissional dominar os recursos disponíveis, interpretar evidências e personalizar o tratamento, contribuindo para melhores desfechos clínicos.

Perguntas frequentes

O que é eletroterapia na fisioterapia?

É a aplicação de correntes elétricas ou energia eletromagnética para tratar disfunções musculoesqueléticas, neurológicas e tegumentares, com objetivos como analgesia, redução de edema e fortalecimento muscular.

Quais são os principais recursos da eletroterapia?

Os principais recursos incluem ultrassom terapêutico, laserterapia, TENS, corrente interferencial (IFC) e estimulação muscular para ganho de força.

As correntes diadinâmicas de Bernard são eficazes para dor e edema?

Um estudo em ratos mostrou que o polo positivo das correntes diadinâmicas de Bernard reduziu a nociceptividade e o edema em trauma tendíneo, mas são necessárias mais pesquisas para confirmar sua eficácia clínica.

Qual a importância da atualização profissional em eletroterapia?

A atualização permite revisar protocolos clínicos, praticar técnicas baseadas em evidências e melhorar a tomada de decisão, garantindo intervenções seguras e eficazes.