A cervical tem afastado muitas pessoas de suas atividades, como trabalho, esporte e lazer. Tarefas simples, como digitar, dirigir e assistir à TV, tornam-se os momentos sobre os quais os pacientes relatam maiores desconfortos.
A cervical
A região cervical possui conexão direta ou indireta com diversas partes do corpo, como a cabeça, o ombro, a caixa torácica e a região lombar. Serve de base de sustentação e aumenta a amplitude de movimento de flexão, extensão, rotação e inclinação do crânio sobre a primeira vértebra cervical (C1). Faz ligação com o ombro por meio dos músculos que interligam a escápula e a clavícula com a cervical.
O posicionamento da região lombar e torácica contribui para um bom ou mau posicionamento da cervical. Fora sofrer influência de todos os segmentos já comentados, alguns músculos da cervical reagem com pontos de tensão mediante estresse. Doenças crônico-degenerativas como hérnia de disco e artrose facetária não costumam ter somente uma causa, mas um conjunto de fatores: má postura ao trabalhar, ler ou assistir a TV, sedentarismo, disfunções em articulações relacionadas com a cervical, movimentos repetitivos, estresse e fatores genéticos. Após um período com algumas dessas alterações, aparecem os primeiros sintomas e, se não tratados, podem causar dores muito fortes e incapacitantes.
Entendendo a coluna cervical
Graças a uma grande flexibilidade da coluna cervical, a cabeça consegue ter uma boa mobilidade em movimentos de girar, estender para trás ou flexionar para frente, por exemplo. A realização desses movimentos é possível, sobretudo, em decorrência do trabalho das articulações da coluna, que também auxiliam na proteção do conteúdo interno – a medula espinhal.
Uma estrutura mais flexível, denominada disco intervertebral, localiza-se entre as vértebras, auxiliando na mobilidade e atuando como uma espécie de “amortecedor” do conjunto de vértebras. Mas com o passar dos anos, o disco pode sofrer graus variáveis de degeneração, ficando mais fino ou até mesmo se deslocando do seu local natural entre as vértebras. O resultado desse fenômeno pode ser a causa da dor na coluna cervical.
Sinais e sintomas
O paciente com cervicalgia costuma adquirir uma atitude de defesa e rigidez dos movimentos, ocorre também uma alteração na mobilidade do pescoço e a dor durante a palpação da musculatura do pescoço podendo também abranger a região do ombro e nos casos mais graves ou prolongados irradiando para todo o membro superior.
Em relação à dor, o paciente pode se queixar desde uma dor leve local e uma sensação de cansaço, até uma dor mais forte e limitante. O braço, além de doer, pode apresentar alterações de sensibilidade e força muscular, são as chamadas “alterações neurológicas”.
O paciente refere adormecimento de alguma área ou de todo o membro, podendo ser contínua ou desencadeada por algum fator. A fraqueza muscular acontece em casos mais graves ou prolongados, sendo geralmente progressiva. Podem existir também alterações nos reflexos encontrados em algumas inserções musculares no punho, cotovelo e ombro nos casos mais graves.
Confira os principais sintomas identificados:
1 – Espasmos musculares nas regiões cervical e supraescapulares.
2 – Diminuição da amplitude de movimento de rotação, lateralização e flexo-extensão da coluna cervical.
3 – Dor que começa na nuca e se irradia para região supraescapular, interescapular e couro cabeludo.
4 – Sensação de peso nos ombros e parte alta das costas. Às vezes, acompanhada de ardência.
5 – Formigamento para ombros e braços.
6 – Cefaleia.
7 – Ao realizar rotação, o paciente relata que sente como se existisse areia entre as vértebras (crepitação).
8 – Fraqueza no ombro e braço, relatando dificuldade de segurar um copo com água ou livro.
Para descartar a possibilidade de outras lesões, como tendinopatias e bursite no ombro ou síndrome do túnel do carpo, é importante uma boa avaliação e diagnóstico diferencial.
Doenças que causam dor na coluna cervical
As doenças que, comumente, causam dor na coluna cervical, são: torcicolo (dor que se limita aos músculos ao redor do pescoço), estenose cervical (formação de osteófitos, mais conhecidos como “bicos de papagaio”, que ocupam espaço e acabam comprimindo áreas onde estão presentes estruturas nervosas, causando dor, formigamentos, dormência e fraqueza), hérnia de disco cervical (ruptura na parte externa do disco intervertebral, o ânulo fibroso, com consequente deslocamento do material interno, o núcleo pulposo, que acaba comprimindo alguma raiz cervical), traumatismos, neoplasias, artrose, etc.
A cervicalgia pode ser decorrente de desordem mecânica, fatores posturais e ergonômicos ou do excesso de sobrecarga dos membros superiores. A dor cervical resulta em perda na produtividade importante em certas ocupações e a maior predisposição de lesão associa-se a certos tipos de atividades e à idade. A cervicobraquialgia, por sua vez, caracteriza-se por dor cervical com irradiação para membro superior, normalmente devido à compressão da raiz nervosa proveniente da região cervical sub-axial. Trabalhos que envolvam movimentos repetitivos de membros superiores e flexão da coluna cervical estão relacionados à dor cervical.
Outros fatores também podem contribuir para o surgimento ou agravamento da dor na coluna cervical.
– Lesões e acidentes;
– Movimentos repetitivos;
– Má postura por muitas horas;
– Estresse ou tensões emocionais.
Hérnia de disco na coluna cervical
A hérnia de disco é uma patologia que pode surgir em toda a extensão da coluna, porém, existem algumas áreas onde a incidência é mais frequente em virtude da maior mobilidade que apresentam de modo particular, é o caso das regiões lombar e cervical.
Essa doença ocorre quando o material (núcleo pulposo) localizado dentro do disco intervertebral (estrutura localizada entre as vértebras da coluna e que ajuda no “amortecimento” dos impactos que a região sofre) é projetado para fora do disco em função de uma ruptura no ânulo fibroso (parte externa do disco), causando a compressão de alguma raiz cervical. As raízes cervicais são responsáveis pela inervação dos membros superiores.
Normalmente, os discos herniados surgem em decorrência de um trauma ou por esforço excessivo. Outros pacientes também podem desenvolver a hérnia de disco cervical em decorrência do envelhecimento que promove o desgaste natural dos discos ou ainda por fatores genéticos. Na verdade, todos nós sofremos uma degeneração natural do disco conforme envelhecemos. O disco tende a desidratar, o que gera fragilidade em sua estrutura e aumenta os riscos de ruptura e, consequentemente, de herniação. Mais fatores de risco: obesidade, postura incorreta, tabagismo, movimentos repetitivos de flexão/torção da coluna vertebral, dentre outros.
Sintomas hérnia de disco
O principal sintoma é a dor, cuja intensidade sempre varia dependendo do quadro clínico do paciente. Outros sintomas podem incluir: sensação de irradiação da dor para outros membros, como o braço ou a mão; formigamentos; alteração da sensibilidade; cãibras; redução de força ou até mesmo travamento, etc.
Os principais exames para auxílio no diagnóstico da hérnia de disco são as radiografias e a ressonância magnética. A maior parte dos casos (cerca de 90%) de hérnia de disco é resolvida com o tratamento conservador, sem procedimentos agressivos.
Relação cervical e escápula
As fibras superiores do trapézio e o músculo elevador da escápula são responsáveis em parte por alguns movimentos da cervical como da escápula também. De tal forma que esses músculos facilmente podem se sobrecarregar mediante fraqueza e pouca utilização de outros músculos estabilizadores cervicais e escapulares. Na ausência dessa divisão de tarefas, esses músculos aumentam sua tensão e ocorrem os nódulos, gerando dor e/ou agudizando dores em processos degenerativos pré-existentes.
Postura
Uma cabeça relativamente anterior em relação aos ombros pode sobrecarregar nas estruturas posteriores da cervical. Com o indivíduo de perfil, uma postura ideal seria que suas orelhas estivessem alinhadas com seus ombros. Assim, a cabeça estaria com 1/3 posterior em relação à linha dos ombros e 2/3 à frente. Quando estamos sentados diante de um computador, e colocamos nossa cabeça à frente, 100% do peso da nossa cabeça está na frente da linha dos ombros, gerando sobrecarga nos discos na região posterior da cervical.
O portador de cervicalgia deve evitar quais posturas?
As posturas sentada ou deitada com flexão de cabeça mantidas por longos períodos, e a postura de inclinação lateral da cabeça e elevação do ombro. A utilização do membro superior em elevação durante muito tempo também deve ser evitado, comum entre bibliotecários, cabeleireiros, garçons e outros. A cada 50 minutos deve ser feito um alongamento muscular e neural nessas regiões da cervical e membros superiores.
Posição para dormir
A posição para dormir também pode ser determinante. Em muitos casos, o tipo de travesseiro ou de colchão acaba respondendo pelas dores na região do pescoço e na nuca. Como boa parte da vida estamos sobre o colchão e o travesseiro, os mesmos são determinantes para manutenção de um bom alinhamento da coluna vertebral. O colchão deve ser semi-ortopédico e com densidade apropriada a cada indivíduo. O travesseiro não pode ser alto, deixando a cabeça fora do alinhamento.
Você pode dormir em decúbito lateral com um travesseiro entre os joelhos, outro apoiando a cabeça no espaço vazio entre a cabeça e o ombro e outro dando suporte ao membro superior contra-lateral. Também em decúbito dorsal, com um travesseiro no espaço da cervical na altura onde a cabeça possa ficar em linha neutra e outro abaixo dos joelhos. E deve evitar dormir de bruços, pois essa postura pode provocar uma rotação cervical mantida por longo período, gerando um desalinhamento entre as colunas.
Relação da cervicalgia com as alterações posturais
As alterações posturais têm grande responsabilidade pela maioria dessas dores que podem iniciar lenta e progressivamente devido aos encurtamentos musculares, que vão se formando nas regiões anterior e posterior da cervical bem como na superior do ombro. O paciente apresenta frequentemente uma cabeça anteriorizada em relação à coluna dorsal, uma extensão da cabeça em relação ao pescoço ou inclinações laterais da cabeça ou do pescoço, que podem ser de alteração leve, moderada ou grave. Depende do nível dos encurtamentos, podendo ser também de origem súbita com dor mais intensa após dormir em posturas inadequadas ou execução de um movimento brusco. Pode ocorrer em função da amplitude normal de movimento durante uma atividade funcional.
Dicas de postura para prevenir dores na cervical
– Prefira dormir de barriga para cima a dormir de bruços, usando um travesseiro com altura suficiente para apoiar a curvatura natural da cervical, ou de lado colocando outro travesseiro entre as pernas para não forçar a coluna.
– Não leia na cama apoiado por travesseiros, procure sentar-se com as costas apoiadas e o livro no colo sobre uma almofada.
– No computador sente-se sem curvar o pescoço, mantendo o topo da tela rente à altura dos olhos. Faça movimentos de rotação com a cabeça para aliviar a tensão.
– Procure não prender o telefone entre a cabeça e o ombro, opte por um headset ou viva voz.
– Regule o encosto do banco do carro de maneira que a curvatura acolchoada se encaixe na curvatura de sua cervical. Isso evita o efeito “chicote” nos acidentes de trânsito.
– O excesso de peso na mochila tenciona a musculatura do pescoço. Ao andar deixe a musculatura ereta e não deixe a mochila causar desequilíbrio. Evite bolsas muito pesadas mesmo em um lado só do corpo.
Tratamento e prevenção de dores na cervical
Após uma avaliação minuciosa, é planejada para o paciente uma sequência de tratamento, escolhida de acordo com as necessidades detectadas na avaliação, fazendo com que o tratamento seja individualizado, e não um mesmo tratamento para todos. Dessa forma, o paciente é classificado em um ou mais subgrupos de dor cervical. Entre as técnicas que podem ser selecionadas, estão a tração, fisioterapia manual e exercícios para estabilização cervical e escapular. Para prevenir novas dores, o indivíduo deve dar continuidade aos exercícios selecionados para a melhora de suas debilidades.
Por ser uma queixa frequente, quando o tratamento fisioterápico é indicado?
A Fisioterapia é indicada tanto no caso das cervicalgias agudas como nas crônicas, pois existem métodos adequados para cada estágio, como a Facilitação Neuromuscular proprioceptiva e a Reeducação Postural Global, utilizando contrações isométricas ou isotônicas associadas a técnicas específicas com alongamentos ou relaxamento em posturas apropriadas. É preciso realizar uma avaliação fisioterápica detalhada de modo a observar as alterações que podem ser responsáveis por essa queixa, investigando se a dor é decorrente de um trauma muscular, articular ou de problemas posturais. Sendo assim, o tratamento será indicado conforme o diagnóstico cinesiológico funcional.
Em quais casos o uso do colar cervical (faixa de segurança que restringe o movimento do pescoço) é prescrito?
O uso de colar cervical é indicado a fim de corrigir cervicalgias agudas provocadas por traumas de grande intensidade. Afinal, o colar cervical deixa a coluna em posição neutra, diminuindo a mobilidade, a tensão muscular e a sobrecarga articular, evitando a exacerbação dos sintomas.
Prevenção de dores no pescoço com a ginástica laboral
A ginástica laboral, com ênfase nas posturas de alongamento, são importantes para a prevenção de dores no pescoço, dessa forma, os alongamentos previnem as lesões musculares e neurais, devido seus encurtamentos provocarem um tensionamento nas estruturas periarticulares, sendo responsáveis por várias patologias, a exemplo das tendinopatias, que normalmente iniciam com dores inflamatórias e evoluem para processos degenerativos dos tecidos moles como ligamentos, tendões, bursas, cápsula articular e fibras musculares. Por ser a área de sustentação entre a cabeça e a coluna, a nuca é uma das regiões que concentra todos os excessos a que submetemos nosso organismo.
Exercícios para a coluna cervical
O programa de tratamento para pessoas que sofrem com a cervicalgia inclui exercícios físicos voltados para a coluna cervical.Portanto, o indicado é que os exercícios sejam de fortalecimento e alongamento da aréa, além da desativação dos pontos gatilhos, que são as dores relacionadas a um músculo ou fáscia muscular endurecida e irritável ao toque. Portanto, os exercícios são importantes para fortalecer os músculos que oferecem suporte à coluna cervical e para melhorar a amplitude de movimentos das vértebras cervicais. Mas vale ressaltar a importância de realizar qualquer exercício, apenas, sob a orientação de um profissional.
Qual medicamento é útil para a cervicalgia?
O ideal mesmo é evitar a automedicação. Muitos pacientes acabam adotando por conta própria um tratamento à base de remédios de venda livre, ou seja, que não necessitam de prescrição médica para serem adquiridos. Por um momento, o remédio pode até ajudar a aliviar a dor, mas o problema está na capacidade que muitos medicamentos têm de mascarar o problema, mas não de resolvê-lo. Por isso, todo cuidado é pouco com a ideia de usar medicamentos por conta própria para o tratamento de qualquer dor.
A cervicalgia não se exclui. Alguns analgésicos e anti-inflamatórios não esteroides podem ser administrados para o alívio da dor, assim como relaxantes musculares que ajudam, inclusive, na melhora dos movimentos e rigidez na região. Entretanto, o paciente nunca deve eleger sozinho o melhor medicamento para o seu quadro. A avaliação de um profissional é indispensável para evitar quaisquer riscos, uma vez que ele examinará o indivíduo para o diagnóstico do seu caso e a indicação dos medicamentos mais adequados.
Cirurgia para a coluna cervical é indicada?
São muito raros os casos em que a coluna cervical deve ser submetida à cirurgia. Pacientes com dores nessa região da coluna podem ser tratados, perfeitamente, com procedimentos clínicos, sem manipulações agressivas. Apenas alguns casos, quando há, por exemplo, déficit neurológico progressivo, presença de dor intensa e intratável clinicamente, tumores, fraturas instáveis, entre outras características, o paciente pode ser encaminhado ao tratamento cirúrgico, mas o tipo de cirurgia indicada vai depender de cada quadro.
Tratamento não cirúrgico para a coluna vertebral
Uma técnica de tratamento foi desenvolvida pelo ITC Vertebral para a coluna vertebral sem procedimentos invasivos. Os pacientes são tratados de acordo com os sintomas e sinais da dor. Não existe um trabalho padrão e é aí que consiste um dos grandes diferenciais do ITC Vertebral: o indivíduo passa por uma avaliação criteriosa, sendo direcionado, a partir dessa primeira etapa, para um atendimento personalizado. Fala-se, portanto, em “Subclassificação” das dores na coluna vertebral, os critérios de tratamento obedecem às características individuais do estado clínico do paciente.
Esse trabalho é baseado numa pesquisa científica que foi iniciada em 1995 em Pittsburg, EUA, depois foi revisada em 2005 e 2010 por Jullie Fritz e publicada nos principais jornais e revistas científicas do mundo. A pesquisa identificou que para cada tipo de dor existem diretrizes de tratamento a serem seguidas, ou seja, as manifestações dolorosas são classificadas e recebem tratamento específico, podendo ser: manipulação ou mobilização articular; a mesa de tração; exercícios direcionais; a estabilização segmentar vertebral e a estabilização dinâmica, que atuam fortalecendo a musculatura profunda da coluna. Esses são os quatro caminhos preconizados pela pesquisa de subclassificação.
Nosso know-how
Nós, do ITC Vertebral, incorporamos a devida pesquisa ao trabalho clínico e acrescentamos à subclassificação os exercícios e o acompanhamento ao paciente no pós-tratamento. A atenção especial ao pós-tratamento (com um programa completo de fortalecimento muscular) é decorrente do caráter degenerativo das lesões na coluna, que não têm cura. O tempo de duração do programa de tratamento não é prolongado, em dois meses são obtidos 87% de bons resultados até em pacientes mais graves.
Assim como o embasamento científico, todos os nossos mais de 236 fisioterapeutas da rede apresentam uma excelente formação técnica com experiências clínicas que capacitam o profissional a atender às demandas individuais dos pacientes.
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