A influência dos pontos-gatilho latente na lombalgia aguda e crônica: um estudo prospectivo longitudinal

Autores

  • Marco Aurélio Nemitalla Added Irmandade da Santa Casa de Misericórdia de São Paulo https://orcid.org/0000-0003-4541-3434
  • Diego Galace de Freitas Irmandade da Santa Casa de Misericórdia de São Paulo
  • Caroline Added Irmandade da Santa Casa de Misericórdia de São Paulo
  • Claudio Cazarini Junior Irmandade da Santa Casa de Misericórdia de São Paulo
  • Patrícia Maria de Moraes Barros Fucs Irmandade da Santa Casa de Misericórdia de São Paulo

DOI:

https://doi.org/10.11606/issn.2317-0190.v31i1a214478

Palavras-chave:

Pontos-gatilho, Dor lombar, Reabilitação

Resumo

A dor lombar é um importante problema de saúde pública e estudos apontam que todas as pessoas que sofrem de dor na coluna apresentam pontos-gatilho. Objetivo: Analisar o nível dor de pacientes com dor lombar aguda e crônica que quando assintomáticos apresentava pontos-gatilho latente, comparado com os níveis de dor de pacientes com dor lombar aguda e crônica que quando assintomáticos não apresentava pontos-gatilho. Método: 96 indivíduos de ambos os sexos entre 18 - 60 anos participaram de um estudo transversal com avaliador cego. Foram analisados o nível de dor, função, atividade física, cinesiofobia, algometria e mensurada a força do músculo glúteo máximo e médio do membro dominante e não dominante, no momento que os participantes estavam assintomáticos e após desenvolverem dor lombar aguda e crônica. Para análise estatística consideramos valores de significância igual ou menor que 0,05. Resultados: Foi observado diferenças significativas entre os grupos na intensidade da dor, funcionalidade, algometria, na dinamometria do músculo glúteo máximo do membro não dominante e da dinamometria do glúteo médio de ambos os membros na lombalgia aguda e diferença significativa da dinamometria do glúteo máximo de ambos os membros na lombalgia crônica. Conclusão: Indivíduos assintomáticos com pontos-gatilho latente nos músculos paravertebrais lombares apresentam pior intensidade da dor e outros desfechos quando desenvolvem dor lombar aguda comparados com indivíduos que não apresentam pontos-gatilho no momento que estão assintomáticos e na lombalgia crônica observamos diminuição da força do glúteo máximo quando comparado com indivíduos com lombalgia aguda.

Downloads

Os dados de download ainda não estão disponíveis.

Referências

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;18;389(10070):736-47. Doi: https://doi.org/10.1016/S0140-6736(16)30970

Nascimento PR, Costa LO. Low back pain prevalence in Brazil: a systematic review. Cadernos de Saude Publica. 2015; 31(6): 1141-56. Doi: https://doi.org/10.1590/0102-311X00046114

Added MA, Costa LO, Freitas DG, Fukuda, TY, Monteiro RL, Salomão EC, et al. Kinesio Taping does not provide additional benefits in patients with chronic low back pain who receive exercise and manual therapy: a randomized controlled trial. J Orthop Sports Phys Ther. 2016; 46(7):506–13. Doi: https://doi.org/10.2519/jospt.2016.6590

Wallwork SB, Braithwaite FA, O'Keeffe M, Travers MJ, Summers SJ, Lange B, et al. The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis. CMAJ. 2024;196(2):E29-E46. Doi: https://doi.org/10.1503/cmaj.230542

Oshima RKA, Vanin AA, Nascimento JP, Kawchuk G, Costa LOP, Costa LDCM. Why do patients with low back pain seek care at emergency department? A cross-sectional study. Braz J Phys Ther. 2022;26(5):100444. Doi: https://doi.org/10.1016/j.bjpt.2022.100444

Oliveira IS, Tomazoni SS, Vanin AA, Araujo AC, Medeiros FC, Oshima RKA, et al. Management of acute low back pain in emergency departments in São Paulo, Brazil: a descriptive, cross-sectional analysis of baseline data from a prospective cohort study. BMJ Open. 2022;12(4):e059605. Doi: https://doi.org/10.1136/bmjopen-2021-059605

Ge HY, Fernández-de-Las-Peñas C, Madeleine P, Arendt-Nielsen L. Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle. Eur J Pain. 2008;12(7):859-65. Doi: https://doi.org/10.1016/j.ejpain.2007.12.005

Chiarotto A, Clijsen R, Fernandez-de-Las-Penas C, Barbero M. Prevalence of Myofascial Trigger Points in Spinal Disorders: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2016;97(2):316-37. Doi: https://doi.org/10.1016/j.apmr.2015.09.021

Dommerholt J, Fernández-de-Las-Peñas C. Trigger point dry needling: an evidence and clinical-based approach. 2nd ed. London: Elsevier; 2018.

Malanga GA, Cruz CE. Myofascial low back pain: a review. Phys Med Rehabil Clin N Am. 2010;21(4):711-24. Doi: https://doi.org/10.1016/j.pmr.2010.07.003

Simons DG, Travell JG. Myofascial pain and dysfunction: the trigger point manual. 3rd ed. Philadelphia: Wolters Kluwer Health: 2019.

Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008;89(1):157-59. Doi: https://doi.org/10.1016/j.apmr.2007.11.016

Money S. Pathophysiology of Trigger Points in Myofascial Pain Syndrome. J Pain Palliat Care Pharmacother. 2017;31(2): 158 – 59. Doi: https://doi.org/10.1080/15360288.2017.1298688

Barbero M, Schneebeli A, Koetsier E, Maino P. Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care. 2019;13(3):270-276. Doi: https://doi.org/10.1097/SPC.0000000000000445

Added MAN, Freitas DG, Added C, Cazarini Junior C, Fucs PMMB. A influência dospontos-gatilho latente na lombalgia aguda: um estudo prospectivo longitudinal. Acta Fisiátr. 2023;30(2):97-104. Doi: https://doi.org/10.11606/issn.2317-0190.v30i2a209429

Costa LC, Maher CG, McAuley J, Hancock MJ, Herbert RD, Refshauge KM, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009;339:b3829. Doi: https://doi.org/10.1136/bmj.b3829

Costa LO, Maher CG, Latimer J, Ferreira PH, Ferreira ML, Pozzi GC, et al. Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: which one is the best? Spine (Phila Pa 1976). 2008;33(22):2459-63. Doi: https://doi.org/10.1097/BRS.0b013e3181849dbe

Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland-Morris. Braz J Med Biol Res. 2001;34(2):203-10. Doi: https://doi.org/10.1590/s0100-879x2001000200007

Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário Internacional de Atividade Física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde. 2001;6(2):5–18. Doi: https://doi.org/10.12820/rbafs.v.6n2p5-18

Ghisi GL, Santos RZ, Felipe TR, Bonin CD, Pinto EF, Guerra FE, et al. Validation of the Portuguese version of the tampa scale for kinesiophobia heart (TSK-SV heart). Rev Bras Med Esporte. 2017;23(3):227-31. Doi: https://doi.org/10.1590/1517-869220172303159416

O'Neill S, Kjaer P, Graven-Nielsen T, Manniche C, Arendt-Nielsen L. Low pressure pain thresholds are associated with, but does not predispose for, low back pain. Eur Spine J. 2011; 20(12):2120-5. Doi: https://doi.org/10.1007/s00586-011-1796-4

Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. vol. 1 - upper half of body. 2nd ed. Pennsylvania: Williams & Wilkins; 1999.

Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. vol. 2 - the lower extremities. 2nd ed. Pennsylvania: Williams & Wilkins; 1999.

Lluch E, Nijs J, Kooning M, Van Dyck D, Vanderstraeten R, Struyf F, et al. Prevalence, Incidence, Localization, and Pathophysiology of Myofascial Trigger Points in Patients With Spinal Pain: A Systematic Literature Review. J Manipulative Physiol Ther. 2015;38(8):587-600. Doi: https://doi.org/10.1016/j.jmpt.2015.08.004

Coelho DM, Barbosa RI, Pavan AM, Oliveira AS, Bevilaqua-Grossi D, Defino HLA. Prevalência da disfunção miofascial em indivíduos com dor lombar. Acta Fisiátr. 2014;21(2):71–74. Doi: https://doi.org/10.5935/0104-7795.20140016

Lingutla KK, Pollock R, Ahuja S. Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis. Eur Spine J. 2016;25(6):1924-31. Doi: https://doi.org/10.1007/s00586-016-4490-8

Coombs DM, Machado GC, Richards B, Oliveira CB, Herbert RD, Maher, CG. Clinical course of patients with low back pain following an emergency department presentation: a systematic review and meta-analysis. Emerg Med J. 2021;38:834-41. Doi: https://doi.org/10.1136/emermed-2019-209294

Jenkins LC, Chang WJ, Buscemi V, Liston M, Skippen P, Cashin AG, et al. Low Somatosensory Cortex Excitability in the Acute Stage of Low Back Pain Causes Chronic Pain. J Pain. 2022;23(2):289-304. Doi: https://doi.org/10.1016/j.jpain.2021.08.003

Cooper NA, Scavo KM, Strickland KJ, Tipayamongkol N, Nicholson JD, Bewyer DC, et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J. 2015;25(4):1258-65. Doi: https://doi.org/10.1007/s00586-015-4027-6

Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34:9–16. Doi: https://doi.org/10.1097/00005768-200201000-00003

Nelson-Wong E, Gregory DE, Winter DA, Callaghan JP. Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clin Biomech (Bristol, Avon). 2008;23(5):545-53. Doi: https://doi.org/10.1016/j.clinbiomech.2008.01.002

Mohamed RR, Abdel-Aziem AA, Mohammed HY, Diab RH. Chronic low back pain changes the latissmus dorsi and gluteus maximus muscles activation pattern and upward scapular rotation: A cross-sectional study. J Back Musculoskelet Rehabil. 2022;35(1):119-127. Doi: https://doi.org/10.3233/BMR-200253

Amabile AH, Bolte JH, Richter SD. Atrophy of gluteus maximus among women with a history of chronic low back pain. PLoS One. 2017;12(7):e0177008. Doi: https://doi.org/10.1371/journal.pone.0177008

Added MA, Freitas DG, Kasawara KT, Martin RL, Fukuda TY. Strengthening the gluteus maximus in subjects with sacroiliac dysfunction: case series. Int J Sports Phys Ther. 2018;13 (1):114–20.

Nuñez-Cortés R, Horment-Lara G, Tapia-Malebran C, Castro M, Barros S, Vera N, et al. Role of kinesiophobia in the selective motor control during gait in patients with low back-related leg pain. J Electromyogr Kinesiol. 2023;71 102793. Doi: https://doi.org/10.1016/j.jelekin.2023.102793

Kayihan G. Relationship between daily physical activity level and low back pain in young, female desk-job workers. Int J Occup Med Environ Health. 2014;27(5):863-70. Doi: https://doi.org/10.2478/s13382-014-0315-3

Ran CG, Grant PM, Dall PM, Gray H, Newton M, et al. Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls: an observational study. Aust J Physiother. 2009;55(1):53-8. Doi: https://doi.org/10.1016/s0004-9514(09)70061-3

Silva T, Mills K, Brown BT, Pocovi N, Campos T, Maher C, et al. Recurrence of low back pain is common: a prospective cohort study. J Physiother. 2019;65(3):159-65. Doi: https://doi.org/10.1016/j.jphys.2019.04.010

Downloads

Publicado

2024-03-31

Edição

Seção

Artigo Original

Como Citar

1.
Added MAN, Freitas DG de, Added C, Cazarini Junior C, Fucs PM de MB. A influência dos pontos-gatilho latente na lombalgia aguda e crônica: um estudo prospectivo longitudinal. Acta Fisiátr. [Internet]. 31º de março de 2024 [citado 18º de julho de 2024];31(1):32-40. Disponível em: https://periodicos.usp.br/actafisiatrica/article/view/214478