Dores de Crescimento

Fonte:Nascer e crescer revista de pediatria do centro hospitalar do porto ano 2012, vol XXI, n.º 4

Autores:Sara Freitas Oliveira1 , Joana Rodrigues1 , Lúcia Rodrigues1 , Mafalda Santos3

RESUMO

 Introdução: As dores de crescimento são uma entidade comum na prática pediátrica. Objectivos: O presente trabalho tem como objectivo fazer uma revisão bibliográfi ca actual sobre a etiologia, apresentação clínica, diagnóstico, diagnóstico diferencial e tratamento das dores de crescimento. Desenvolvimento: Apesar das dores de crescimento terem sido descritas pela primeira vez na literatura médica há 188 anos, até ao momento ainda não é conhecida a sua causa, mas parece que não existe relação entre esta condição e o crescimento. Apresentam -se, geralmente, em crianças entre os três e os 12 anos de idade. Caracterizam -se por dor nos membros inferiores, de tipo simétrico, predomínio nocturno e de curta duração. O seu diagnóstico é clínico e devem excluir -se outras patologias, como por exemplo, tumores ou infecções. Os exames laboratoriais assim como os de imagiologia, quando solicitados, são sempre normais, pelo que qualquer alteração encontrada em algum deles deve fazer pensar noutra patologia. Uma vez estabelecido o diagnóstico, o tratamento deve orientar -se por medidas conservadoras, tais como, massagens, aplicação de calor nas zonas dolorosas ou analgésicos. 

Conclusões: O conhecimento das características desta entidade assume importância em Pediatria para que sejam evitados erros de diagnóstico. 

Palavras -chave: Criança, dores de crescimento, dor nos membros inferiores. Nascer e Crescer 2012; 21(4): 230-233

 INTRODUÇÃO

As dores de crescimento são a causa mais comum de dor musculoesquelética na infância e um motivo frequente de consulta em idade pediátrica(1 -7). Foram mencionadas pela primeira vez na literatura médica em 1823, pelo médico francês Marcel Duchamp. Ele foi o primeiro a notar que um grande número de crianças apresentavam um aumento da frequência de dores musculoesqueléticas e aplicou o termo “dores de crescimento” para as descrever, acreditando que elas eram causadas pelo rápido crescimento esquelético(3,8). Desde então, vários autores investigaram esta condição, contudo a natureza exacta e a etiologia permanecem desconhecidas(2 -5). Alguns autores consideram que a denominação “dores de crescimento” é errada, pois é consensual que o processo de crescimento deve ser indolor, senão todas as crianças deveriam sentir dor. Têm assim surgido na literatura médica denominações alternativas, como “dores nocturnas benignas da infância”(9) ou “dores recorrentes dos membros inferiores”(8). Contudo, a designação “dores de crescimento” é universalmente aceite pois deixa implícito o seu carácter benigno e transitório. O presente trabalho tem como objectivo fazer uma revisão bibliográfi ca actual sobre a etiologia, apresentação clínica, diagnóstico, diagnóstico diferencial e tratamento das dores de crescimento. EPIDEMIOLOGIA As dores de crescimento ocorrem em crianças entre os três e os 12 anos de idade(1,6), com uma frequência ligeiramente superior no sexo feminino segundo algumas séries(10,11). A sua prevalência varia entre 2,6 -49,4% consoante a população estudada, a idade das crianças e a defi nição clínica utilizada(7).

ETIOLOGIA 

A etiologia das dores de crescimento é desconhecida. Contudo, parece que nada têm a ver com o crescimento pois: não coincidem com os períodos de maior crescimento (primeiros dois anos de vida e puberdade); raramente afectam os membros superiores e outras zonas do corpo, que também crescem; e não afectam o crescimento das crianças que as têm(11). Foram propostas várias teorias para tentar explicar as dores de crescimento. A primeira delas, a teoria da fadiga, foi proposta em 1894, por Bennie, sugerindo que a dor ocorreria devido ao uso excessivo das pernas(8). E é um facto que os pais muitas vezes associam os episódios de dor com períodos de maior actividade física da criança(2). Em 1938, surgiu a teoria anatómica, descrita por Hawksley, com base na constatação de que muitos casos de dores de crescimento estavam associados a um defeito postural ou ortopédico (ex. escoliose, lordose, joelho valgo, pé plano)(8). Uma terceira teoria, introduzida em 1951, por Naish e Apley(11), a teoria psicológica ou emocional, propunha que alguns factores psicossociais poderiam mediar esta situação (por ex. famílias disfuncionais, tipo de personalidade depressiva ou ansiosa e stress). Até ao momento, não há estudos que comprovem nenhuma destas teorias.

Na última década, têm sido feitos alguns estudos para tentar determinar a causa das dores de crescimento. O Quadro I apresenta resumidamente três estudos recentes que propõem novas teorias quanto à etiologia das dores de crescimento, tal como se descreve no texto que se segue: Baixo limiar para a dor: O limiar para a dor em crianças com dores de crescimento encontra -se signifi cativamente reduzido em comparação com o grupo controlo. Os autores sugerem que isto poderá indicar que as dores de crescimento são um síndrome doloroso não -infl amatório generalizado que ocorre na infância(12). Diminuição da resistência óssea: A velocidade de transmissão ultrassónica através do osso foi medida usando um ecógrafo e verifi cou -se que a resistência óssea da tíbia em crianças com dores de crescimento era signifi cativamente menor que no grupo controlo. Os autores colocaram como hipótese que a fadiga óssea com a actividade poderia originar as dores nos membros inferiores(13). Perfusão vascular alterada: Para alguns especialistas as dores de crescimento poderiam estar relacionadas com altera- ções da perfusão vascular. No entanto, as cintigrafi as ósseas realizadas não demonstraram diferenças signifi cativas entre as crianças com e sem dores de crescimento(14). Hipermobilidade articular: Há a impressão clínica de que as crianças com dores de crescimento têm hiperlaxidez articular. Contudo, como não há uma ferramenta universalmente válida para avaliar a hipermobilidade nas crianças, esta hipótese ainda não foi testada(9). 

CLÍNICA

 As dores de crescimento ocorrem em crianças em idade pré -escolar e escolar(15). Localizam -se em ambos os membros inferiores (nas coxas, nas pernas e na fossa poplítea). A dor pode também ocorrer nos membros superiores, mas apenas em conjugação com dor nos membros inferiores. Em geral, não envolve as articulações. As crianças quase nunca referem um ponto doloroso concreto com o dedo, mas sim deslizam a palma da mão sobre as zonas dolorosas. Surge ao fi m do dia ou à noite e pode acordar a criança, mas na manhã seguinte, quando ela se levanta, não apresenta qualquer dor e é capaz de realizar as suas actividades normais. Geralmente dura menos de 30 minutos e tem uma intensidade variável, desde muito ligeira a muito intensa. A dor é caracteristicamente intermitente, alternando a sua presença com intervalos sem dor que podem ser de dias a meses, apesar de em algumas ocasiões poderem apresentar -se diariamente(4,6,10,11).

A literatura médica refere que, durante e após os episódios de dor, não são evidentes alterações musculoesqueléticas nem articulares no exame objectivo(6). Aproximadamente um terço dos casos estão associados a dor abdominal recorrente e/ou cefaleias. É comum haver história familiar de dores de crescimento ou de queixas reumáticas(4,10,11). 

DIAGNÓSTICO 

Não existe nenhum exame complementar que permita fazer o diagnóstico de dores de crescimento. Assim, perante uma criança saudável com uma apresentação típica, que permanece sem dor durante o dia, o diagnóstico pode geralmente ser feito com base em critérios de inclusão e de exclusão (Quadro II) (2, 10). Um estudo caso -controlo recente, concluiu que as dores de crescimento permanecem um diagnóstico clínico e que se forem considerados critérios de inclusão e de exclusão precisos, não há necessidade de exames laboratoriais para estabelecer o diagnóstico(16). Perante quadros clínicos com características atípicas ou na presença de critérios de exclusão, será prudente solicitar exames complementares, como por exemplo, hemograma completo, velocidade de sedimentação ou proteína C reactiva e/ou radiografi as. Se for detectada alguma alteração nos resultados destes exames, exclui -se o diagnóstico de dores de crescimento. 

DIAGNÓSTICO DIFERENCIAL 

O diagnóstico diferencial de dor intermitente nos membros inferiores é extenso. No entanto, de seguida é feita uma breve referência às principais patologias a ter em conta, a maioria das quais pode ser excluída com base na história clínica e no exame físico(4). O traumatismo é uma causa comum de dor nos membros. Poderá haver história de traumatismo e podem ser visíveis equimoses ao exame objectivo. Geralmente não causa dor crónica e intermitente, típica das dores de crescimento. As infecções, como por exemplo a artrite séptica e a osteomielite aguda, estão habitualmente associadas a doença febril e difi cilmente se confundem com dores de crescimento. Contudo, a apresentação clínica clássica pode estar ausente se a infecção estiver a ser parcialmente tratada com antibióticos. Os tumores ósseos são muitas vezes esquecidos. No  caso de tumores malignos, como o osteossarcoma ou o sarcoma de Ewing, a dor é persistente e de severidade crescente. O osteoma osteóide é um tumor benigno, caracterizado por dor intermitente, unilateral, que geralmente piora à noite e pode interromper o sono. A criança com leucemia ocasionalmente apresenta dor óssea vaga, mas poderá também ter outros sinais/sintomas como por exemplo, febre recorrente, palidez e petéquias. No caso das osteonecroses, de que é exemplo a Doença de Legg -Calvé -Perthes, a criança apresenta diminuição da mobilidade da anca. A anemia de células falciformes e a hemofi lia são outros dois diagnósticos diferenciais a considerar. O primeiro deverá ser pensado em crianças de raça negra com dor nos membros e anemia. As hemartroses são comuns em casos moderados a severos de hemofi lia. As doenças reumáticas, particularmente as espondilartropatias como a artrite psoriática e a artrite reactiva, podem causar dor nocturna. Finalmente, casos subtis de raquitismo podem ser confundidos com dores de crescimento. TRATAMENTO Em muitos casos bastará o esclarecimento da família acerca da natureza benigna destes episódios, evitanto deste modo preocupações e medos desnecessários. Muitas crianças obtêm alívio da dor com a massagem das zonas dolorosas ou através da aplicação de calor local. Na maioria dos casos não está indicada a administração de qualquer medicamento pois as dores são de curta duração. Nos casos mais aparatosos poderá estar indicado o tratamento sintomático com analgésicos (por ex. paracetamol ou ibuprofeno). Em crianças com episódios muito frequentes, pode ser útil a administração de analgésicos preventivos à tarde (por ex. naproxeno). Exercícios de estiramento muscular podem aliviar as crianças com sintomas crónicos. Em 1988, Baxter e Dulberg, fi zeram um estudo com 36 crianças com dores de crescimento, e verifi - caram que as crianças tratadas com um regime de exercícios de estiramento muscular obtinham resolução mais rápida dos seus sintomas que as crianças do grupo controlo(4). Contudo, não está claro até que ponto a melhoria ocorreu devido ao exercício ou devido ao aumento da atenção por parte dos pais que era requerida duas vezes por dia. 

PROGNÓSTICO 

O prognóstico das dores de crescimento é muito bom. Não estão associadas a nenhuma patologia orgânica séria e em 100% dos casos as dores desaparecem com a idade(6). Na maioria dos casos, ocorre resolução até 24 meses após o início. 

CONCLUSÃO

 As dores de crescimento são uma entidade frequente na prática pediátrica. Até à actualidade ainda não é conhecida a sua etiologia. O seu diagnóstico é clínico, com base em critérios de inclusão e de exclusão. É importante conhecermos as suas características de modo a evitarmos duas situações: por um lado atribuir o diagnóstico de “dores de crescimento” a situações claramente orgânicas e que podem ser graves e por outro lado solicitarmos exames complementares a crianças com quadros típicos de dores de crescimento.

BIBLIOGRAFIA 

1. Uziel Y, Hashkes P. Growing pains in children. Pediatr Rheumatol Online J 2007, 5:5. 

2. Evans A, Scutter S, Lang L, Dansie B. “Growing pains” in young children: a study of the profi le, experiences and quality of life of four to six year old children with recurrent leg pain. Foot 2006; 16: 120 -4. 

3. Kaspiris A, Zafi ropoulou C. Growing pains in children: epidemiological analysis in a Mediterranean population. Joint Bone Spine 2009; 76: 486 -90. 

4. Leung A, Robson W. Growing pains. Can Fam Physician 1991; 37:1463 -7. 

5. González B: Dolores de crecimiento en niños – mitos o verdaderos? Rev. Med. Clin. Condes 2009; 20: 892 -6.

 6. Amador EV, Perilla R, Álvarez G. Dolor de crecimiento. Revisión de la literatura. Revista Col Or Tra 2008; 22: 192 -5.

 7. Evans AM, Scutter SD. Prevalence of “growing pains” in young children. J Pediatr 2004; 145: 255 -8. 

8. AL -Khattat A, Campbell J. Recurrent limb pain in childhood (‘growing pains’). Foot 2000; 10: 117 -23. 

9. Malleson PN, Sherry DD. Noninfl ammatory musculoskeletal pain conditions. In: Cassidy JT, Petty RE ed. Textbook of Pediatric Rheumatology. Philadelphia: Elsevier Saunders, 2005: 676 -96. 10. Abu -Arafeh I, Russel G. Recurrent limb pain in school children. Arch Dis Child 1996; 74: 336 -9. 

11. Naish JM, Apley J. ‘Growing pains’: a clinical study of non- -arthritic limb pains in children. Arch Dis Child 1951; 26: 134- -40. 

12. Uziel Y, Chapnick G, Jaber L, Nemet D, Hashkes P. Five -year outcome of children with “growing pains”: correlations with pain threshold. J Pediatr 2010; 146: 838 -40. 

13. Friedland O, Hashkes PJ, Jaber L, Cohen HA, Eliakim A, Wolach B, et al. Decreased bone strength in children with growing pains as measured by quantitative ultrasound. J Rheumatol 2005; 32: 1354 -7. 

14. Hashkes PJ, Gorenberg M, Oren V, Friedland O, Uziel Y. “Growing pains” in children are not associated with changes in vascular perfusion patterns in painful regions. Clin Rheumatol 2005; 24: 342 -5. 

15. Evans A. Growing pains: contemporary knowledge and recommended practice. J Foot Ankle Res 2008; 1: 4. 

16. Asadi -Pooya AA, Bordbar MR. Are laboratory tests necessary in making the diagnosis of limb pains typical for growing pains in children? Pediatr Int 2007, 49: 833 -5.

Pilates Takes to the Field

Autor:  Zuzana Machotka

Source: https://www.premax.co/au/blog-contributor/zuzana-machotka

By now most people have heard of Pilates. But what is Pilates? Staff at the School of Science and Health, University of Western Sydney reviewed 119 Pilates research papers in order to define Pilates. They defined it as “… a mind-body exercise that requires core stability, strength, and flexibility, and attention to muscle control, posture, and breathing.”(Wells, Kolt et al. 2012) In expert hands, Pilates' allows the difficulty of exercises to be modified and therefore tailored to individuals. Specific goals can be set and individual limitations can be addressed through Pilates exercise. Intensity and complexity can be increased over time as the body and mind adapt to the exercises.

Elite sporting clubs around the world incorporate Pilates into their athletes’ weekly exercise routines. The rationale for including Pilates within an athlete’s training schedule is usually to prevent injuries, improve performance and complement existing rehabilitation programs (e.g. weight training). For example, players in the English Cricket Team regularly practice Pilates to maintain the power of their bowling action and prevent overuse injuries. Australian aerial skier and winter Olympic gold medallist Lydia Lassila travels around the world with her own Pilates equipment to prevent and rehabilitate low back pain. Kobe Bryant travels with his own Pilates instructor to maintain his agility and flexibility.

But is Pilates only for the stars? No. Pilates is incredibly popular in the recreational sporting population. In people without back pain or other injuries, Pilates can improve abdominal muscular endurance, dynamic balance, and back muscle flexibility. (Campos, Dias et al. 2016). These improvements may help to prevent future episodes of injury and help people perform better at work or in sport. Interestingly hamstring strains are one the most common musculoskeletal injuries seen in all football codes. Lack of flexibility, specifically short muscle fascicle length, can be a limiting factor for sporting performance and can contribute to muscular injuries.(Timmins, Bourne et al. 2015) In a small study of soccer players, Pilates improved hamstring flexibility.(Chinnavan, Gopaladhas et al. 2015)

The founder of Pilates, Joseph Pilates, came from a background of boxing, self-defence and wrestling, which at the time were male-dominated sports. Joseph Pilates originally used his method to train German soldiers who were rehabilitating from their injuries. Today, Pilates exercises are often used to treat chronic low back and pelvic girdle pain and are viewed by some as a form of exercise only for women. However, Pilates can lead to greater control of the muscles of the trunk and pelvic floor and thereby improve core stability for both genders. By incorporating breathing techniques and movement control, Pilates can strengthen weak areas and promote a more efficient transfer of energy from the trunk to the arms and legs – a key component of sports performance.

Image: Pilates Reformer

As a Sports Physiotherapist and AFL Pilates instructor I have seen the benefits of Pilates in improving movement patterns and performance in footballers. Both professional and recreational athletes can use the principles of Pilates to improve co-ordination, mobility and flexibility all of which are essential for optimum sporting performance. Pilates exercises can target aspects of strength and flexibility that everyday exercises cannot. Pilates can help athletes recover from injuries and help change patterns of movement that can lead to future injuries.

References

Campos, R. R., et al. (2016). "Effect of the Pilates method on physical conditioning of healthy subjects: A systematic review and meta-analysis." Journal of Sports Medicine and Physical Fitness 56(7-8): 864-873.

Chinnavan, E., et al. (2015). "Effectiveness of pilates training in improving hamstring flexibility of football players." Bangladesh Journal of Medical Science 14(3): 265-269.

Timmins, R. G., et al. (2015). "Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study." British journal of sports medicine: bjsports-2015-095362.

Wells, C., et al. (2012). "Defining Pilates exercise: A systematic review." Complementary Therapies in Medicine 20(4): 253-262.

Health Parliament Portugal

http://healthparliament.pt/

Junte-se a nos para pensar o futuro

Depois do Parlamento Europeu e do Reino Unido, é a vez de Portugal receber o primeiro Parlamento 100% dedicado à saúde. Health Parliament Portugal tem, à semelhança do que aconteceu nas duas edições passadas, o ambicioso objetivo de discutir políticas de saúde.

E esse processo vai estar na mão de 60 jovens entre os 21 e os 40 anos. Esta iniciativa é uma parceria da Janssen, comanhia farmaceutica do grupo Johnson&Johnson, com o Expresso, a Microsoft e a Universidade Nova de Lisboa. Os participantes podem ser de várias áreas, tendo apenas que contribuir para a discussão com as suas ideias.

Entre setembro e junho, o sistema de saúde está nas mãos deles. E vão dividir-se em grupos de seis com o objetivo de discutir temas estruturantes:

• O doente no centro da decisão: que impacto sobre os profissionais e cuidados de saúde?
• Ética: o que espera a sociedade dos cuidados de saúde?
• Saúde Mental: de parente pobre a investimento com retorno?
• Barreiras aos cuidados de saúde: que desafios demográficos, realidades locais e futuras respostas?
• Tecnologias de informação em Saúde: que promessa tecnológica e desafios sociais?
• Economia do Conhecimento: como potenciar o impacto da I&D na economia?

Este projeto será acompanhado por um Conselho Consultivo composto por deputados de todos os quadrantes e académicos reconhecidos, além de curadores que irão acompanhar a discussão e marcar presença nos eventos. Vamos pensar a saúde em Portugal?

MÚSCULOS DO PESCOÇO

Os músculos da região do pescoço de uma forma didática podem ser divididos  em 5 regiões:

	Região Anterior do Pescoço
	Platisma ou Cutâneo do Pescoço

Músculos Supra-hioideos		Músculos Infra-hioideos
Digástrico Estiloideo Miloiódeo Genioideo		Esternohióideo Esternotireoideo Tireoide Omoioideo
Região Lateral do Pescoço		Região Pré-Vertebral
Esternocleidomastoideo Escaleno Anterior Escaleno Médio Escaleno Posterior Reto Lateral da Cabeça		Longo da Cabeça Reto Anterior da Cabeça Longo do Pescoço

Região Anterior do Pescoço:

PLATISMA

Inserção Superior: Face inferior da mandíbula, pele da parte inferior da face e canto da boca

Inserção Inferior: Fáscia que recobre as partes superiores dos músculos peitoral maior e deltoide

Inervação: Ramo Cervical do Nervo Facial (7º par craniano)

Ação: Traciona o lábio inferior e o ângulo bucal, abrindo parcialmente a boca (expressão de horror). Puxa a pele sobre a clavícula em direção à mandíbula.

Região do Osso Hioide – Músculos Supra-Hioideos

1. DIGÁSTRICO

Inserção Superior:

Ventre Anterior: Fossa digástrica da mandíbula

Ventre Posterior: Processo mastoide

Inserção Inferior: Corpo do osso hioide

Inervação: Nervo Facial (ventre posterior) e Nervo Mandibular (ventre anterior)

Ação: Elevação do Osso Hioide e Abaixamento da Mandíbula (abertura da boca). O ventre anterior traciona o osso hioide para frente e o ventre posterior para trás.

2. ESTILOIDEO

Inserção Superior: Processo estiloide

Inserção Inferior: Corpo do osso hioide

Inervação: Nervo Facial (VII par craniano)

Ação: Elevação e Retração do Osso Hioide.

3. MILOIÓDEO

Inserção Superior: Linha milo-hioidea da mandíbula

Inserção Inferior: Corpo do osso hioide

Inervação: Nervo Mandibular (Ramo do nervo Trigêmeo – V par craniano)

Ação: Elevação do osso Hioide e da Língua.

4. GENIOIDEO

Inserção Superior: Espinha mentoniana da mandíbula

Inserção Inferior: Corpo do osso hioide

Inervação: Nervo Hipoglosso (C1)

Ação: Tração Anterior do osso Hioide e da Língua.

Região do Osso Hioide – Músculos Infra-Hioideos

1.  ESTERNOHIÓIDEO

Inserção Superior: Corpo do osso hioide

Inserção Inferior: Face posterior do
manúbrio do esterno e ¼ medial da clavícula

Inervação: Ramos da Alça Cervical (N. do Hipoglosso) com fibras de C1 à C3

Ação: Baixar o Osso Hioide.

2.  ESTERNOTIREOIÓIDEO

Inserção Superior: Cartilagem tireoide

Inserção Inferior: Face posterior do manúbrio do esterno

Inervação: Ramos da Alça Cervical (N. do Hipoglosso) com fibras de C1 à C3

Ação: Baixar a Cartilagem Tireoide

3. TIREÓIDEO

Inserção Superior: Corno maior do osso hioide

Inserção Inferior: Cartilagem tireoide

Inervação: Nervo do Hipoglosso (C1 e C2)

Ação: Baixar o Osso Hioide.

4. OMOIOIDEO

Inserção Superior: Corpo do osso hioide

Inserção Inferior: Borda superior da escápula

Inervação: Ramos da Alça Cervical (N. do Hipoglosso) com fibras de C1 à C3

Ação: Baixar o Osso Hioide.

Região Lateral do Pescoço

1. ESTERNOCLEIDOMASTOIDEO

Inserção Superior: Processo mastoide e linha nucal superior

Inserção Inferior: Face anterior do manúbrio do esterno junto à face superior e borda anterior
do 1/3 medial da clavícula

Inervação: C2, C3 e parte espinhal do nervo Acessório (11º par craniano)

Ação:

* Fixo Superiormente: Ação Inspiratória

* Fixo Inferiormente:

Contração Unilateral: Flexão, Inclinação Homolateral e rotação com a face virada para o lado oposto

Contração Bilateral: Flexão da Cabeça.

2. ESCALENO ANTERIOR

Inserção Superior: Tubérculos anteriores dos processos transversos da 3ª à 6ª vértebras cervicais

Inserção Inferior: Face superior da 1º costela (tubérculo do escaleno anterior)

Inervação: Ramos dos nervos cervicais inferiores

Ação: Elevação da primeira Costela e inclinação Homolateral do Pescoço – Ação Inspiratória.

3. ESCALENO MÉDIO

Inserção Superior: Tubérculos anteriores dos processos transversos da 2ª à 7ª vértebras cervicais

Inserção Inferior: Face superior da 1ª costela

Inervação: Ramos dos nervos cervicais inferiores

Ação: Elevação da primeira Costela e Inclinação Homolateral do Pescoço – Ação Inspiratória.

4. ESCALENO POSTERIOR

Inserção Superior: Tubérculos posteriores dos processos transversos da 5ª à 7ª vértebras cervicais

Inserção Inferior: Borda superior da 2ª costela

Inervação: Ramos anteriores dos 3 últimos nervos cervicais

Ação: Elevação da segunda costela e inclinação homolateral do pescoço – Ação inspiratória

TESTE SEUS CONHECIMENTOS SOBRE O SISTEMA MUSCULAR

5. RETO LATERAL DA CABEÇA

Inserção Superior: Processo jugular do occipital

Inserção Inferior: Processo transverso de atlas

Inervação: Ramo da alça cervical entre o 1º e 2º nervos cervicais

Ação: Inclinação Homolateral da Cabeça.

Região Pré-Vertebral

1. LONGO DA CABEÇA

Inserção Superior: Processo basilar do occipital

Inserção Inferior: Tubérculos anteriores dos processos transversos da 3ª à 6ª vértebras cervicais

Inervação: C1, C2 e C3

Ação: Flexão da Cabeça.

2. RETO ANTERIOR DA CABEÇA

Inserção Superior: Processo basilar do occipital

Inserção Inferior: Processo transverso e superfície anterior de atlas

Inervação: Ramo da alça cervical entre C1 e C2

Ação: Flexão da Cabeça.

3. LONGO DO PESCOÇO

Porção Oblíquo Superior:

Inserção Superior: Tubérculo do arco anterior do Atlas

Inserção Inferior: Tubérculo anterior dos processos transversos de C3 e C5

Porção Oblíquo Inferior:
Inserção Superior: Tubérculo anterior dos processos transversos de C5 e C6

Inserção Inferior: Corpos vertebrais de T1 a T3

Porção Vertical:
Inserção Superior: Corpos vertebrais de C2 a C4

Inserção Inferior: Corpos vertebrais de C5 a T3

Inervação: Ramos de C2 à C7

Ação: Flexão do Pescoço e Inclinação Homolateral

MÚSCULOS DO PESCOÇOVista Anterior

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000

MÚSCULOS DO PESCOÇOVista Lateral

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000.

MÚSCULOS DO PESCOÇOSupra e Infra-hioideos

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000.

MÚSCULOS DO PESCOÇOSupra e Infra-hioideos

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000.

MÚSCULOS DO PESCOÇOGênio-hioideo

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000.

MÚSCULOS DO PESCOÇOMilo-hioideo

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000.

MÚSCULOS DO PESCOÇOEscalenos e Pré-Vertebrais

Fonte: NETTER, Frank H.. Atlas de Anatomia Humana. 2ed. Porto Alegre: Artmed, 2000.

Core Stability in Athletes: A Critical Analysis of Current Guidelines

https://link.springer.com/article/10.1007/s40279-016-0597-7

• Authors
• Authors and affiliations

• Klaus Wirth 
• Hagen HartmannEmail author
• Christoph Mickel
• Elena Szilvas
• Michael Keiner
• Andre Sander
• 
  

Abstract

Over the last two decades, exercise of the core muscles has gained major interest in professional sports. Research has focused on injury prevention and increasing athletic performance. We analyzed the guidelines for so-called functional strength training for back pain prevention and found that programs were similar to those for back pain rehabilitation; even the arguments were identical. Surprisingly, most exercise specifications have neither been tested for their effectiveness nor compared with the load specifications normally used for strength training. Analysis of the scientific literature on core stability exercises shows that adaptations in the central nervous system (voluntary activation of trunk muscles) have been used to justify exercise guidelines. Adaptations of morphological structures, important for the stability of the trunk and therefore the athlete’s health, have not been adequately addressed in experimental studies or in reviews. In this article, we explain why the guidelines created for back pain rehabilitation are insufficient for strength training in professional athletes. We critically analyze common concepts such as ‘selective activation’ and training on unstable surfaces.

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