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


• Zadro et al. (2020) High‐ and low‐value care in sport and exercise medicine: areas for consideration. Translational Sports Medicine.


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.


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


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


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

https://link.springer.com/book/10.1007/978-1-4419-5973-7


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


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


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

https://ylmsportscience.com/


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

https://footballmedicine.net/abc-of-football-medicine-lesson-5-risk-factor-assessment/


• 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

https://journals.humankinetics.com/view/journals/jsr/jsr-overview.xml

https://journals.lww.com/nsca-jscr/toc/2016/01000

https://ylmsportscience.com/


• 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


• 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

https://journals.humankinetics.com/view/journals/ijspp/ijspp-overview.xml


Fatores de Risco

• Suvarna et al. (2020) Health risk behaviours and allostatic load: A systematic review. Neuroscience and Biobehavioral Reviews. 694 - 711


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


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



• 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



• 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


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?


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


Reabilitação – Abordagem geral

• Isokinetic: Periodised, individualised & mixed Methods NMT em https://www.isokinetic.com/en/

https://www.isokinetic.com/en/


• 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


Reabilitação – Exercícios Específicos Isquio-tibiais


• Strength and Conditioning Research de Chris Beardsley em https://www.strengthandconditioningresearch.com/

Reabilitação – Exercícios Específicos Quadricípite

https://www.strengthandconditioningresearch.com/


• 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


Reabilitação – Exercícios Específicos Trícipite Sural


• 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


Reabilitação - Geral


Manutenção Sistemas Energéticos Outras qualidades de forçaTécnica de Movimento


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



Reabilitação – Return-to-Play


• Vanrenterghem (2017) Training Load Monitoring in Team Sports: A Novel Framework Separating Physiological and Biomechanical Load-Adaptation Pathways. Sports Med.


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



• 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


Reabilitação – Return-to-Play, Quadricípite, Adutores, Trícipite Sural


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


➢ 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



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


• 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

Apresentação do PowerPoint...Br J Sports Med. 342-350 • Pollock et al. (2014) British athletics...

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