Coluna vertebral: somos referência em tratamentos

itc vertebral jundiaí

Para você entender tudo o que acontece com a coluna vertebral, vamos começar por sua forma e sua anatomia. A coluna vertebral é constituída por uma série de ossos, que são chamados de vértebras. Então, vamos conhecer o conjunto de vértebras, que é dividido em quatro regiões, que são:

  • cervical (pescoço), com sete vértebras;
  • torácica (tronco), com doze vértebras;
  • lombar (região da cintura), com cinco vértebras;
  • sacro (região do quadril), com cinco vértebras fundidas;

O cóccix (ponta final da coluna) tem de quatro a cinco vértebras, também fundidas, já o sacro é a base da coluna vertebral que se articula também com a bacia. Assim, as alterações que ocorrem nessa região poderão trazer muitos problemas para a coluna.

A coluna vertebral, vista de frente ou de costas, deve ser reta. Quando ela é vista de perfil (lateral), cada região se apresenta com curvatura específica, o que chamamos de lordose ou de cifose.

É muito comum encontrarmos pessoas com essas linhas acentuadas (hiperlordose ou hipercifose), assim como encontramos também pessoas sem essas curvaturas. Quando isso acontece, chamamos de zonas planas ou com o segmento retificado.

Divisão da coluna

Coluna Cervical (C1 a C7) – pescoço

Na parte alta, encontramos a coluna cervical (pescoço) e suas sete vértebras: Vértebra Cervical 1 (C1), Vértebra Cervical 2 (C2) e, assim, sucessivamente: C3, C4, C5, C6 e C7. Desse conjunto, apenas duas vértebras da coluna cervical não têm um disco intervertebral interposto entre elas: C1 e C2. Nessa região, a curvatura é chamada de lordose cervical. Esse é o segmento de maior mobilidade da coluna vertebral. Quando essas curvaturas não existem ou estão alteradas, isso é sinal de problema postural e geralmente é causa de dores e degeneração dos discos e de vértebras. Esse conceito é aplicado para todo o segmento vertebral; ou seja, essas alterações de curvaturas nas regiões torácica ou lombar provocam as mesmas consequências. A coluna vertebral e os discos aumentam de tamanho e de volume da região cervical para lombar. Portanto, as vértebras e os discos intervertebrais na coluna cervical são os mais estreitos.

Coluna Torácica (T1 a T12) – tronco

Na parte média, encontramos a coluna torácica com suas 12 vértebras – de cima para baixo chamamos de Torácica 1 (T1), Torácica 2 (T2) e, assim, sucessivamente, até T12. Temos nessa região 12 pares de costelas, dos quais 7 pares se articulam com o osso esterno (o osso que fica entre o lado direito e o lado esquerdo do peito). São chamadas também de costelas verdadeiras. Outros três pares de costelas se articulam com a cartilagem do esterno – são chamadas de falsas. As duas últimas são flutuantes, pois estão soltas, fixas apenas na porção posterior da coluna vertebral. Elas não se articulam com o esterno.

A curvatura do segmento torácico é oposta às curvaturas da lombar e cervical – é chamada de cifose torácica. Na pessoa idosa essa região tende a ficar mais proeminente, em virtude de uma fraqueza muscular, desidratação e diminuição dos discos. Sendo assim, idoso tem uma tendência de ficar com o tronco mais curvado para frente e de olhar para baixo, além de uma certa dificuldade respiratória. Essas curvaturas, quando são acentuadas, são chamadas de hipercifose. Por isso, o mais importante é que existem técnicas posturais de fisioterapia que auxiliam o idoso a se manter bem posturado. Devido ao gradil costal, essa região tem pouca mobilidade. Dessa forma, os discos e as vértebras são mais protegidos de lesões.

Coluna Lombar (L1 a L5) – região da cintura

Na região baixa, você vai encontrar a coluna lombar com suas cinco vértebras lombares, que são chamadas de Lombar 1 (L1)1, L2 até a Lombar 5 (L5). Essas abreviaturas são encontradas com mais frequência nos laudos dos exames complementares como raio X, tomografias e ressonância nuclear magnética. A sua curvatura é lordótica. Ou seja, essa é a região da coluna que mais recebe carga entre as vértebras. E então, como consequência, é o segmento mais acometido de toda a coluna vertebral. Essa região realiza grandes movimentos de flexão anterior e posterior, um bom movimento de lateralidade e poucos graus de rotação. Por isso, alguns autores descrevem que as curvaturas lordóticas têm como função realizar movimentos, e as curvaturas cifóticas têm como função realizar proteção de órgãos e estruturas nobres do nosso corpo. Por exemplo, a região torácica, com sua cifose, protege os pulmões e o coração.

Sacro e Cóccix

No segmento mais inferior da coluna, encontramos o sacro e o cóccix. O sacro tem um papel fundamental na biomecânica da coluna vertebral. Por causa de suas comunicações com os ossos da bacia, ele tem uma função fundamental na nossa postura e determina a angulação da nossa coluna.

Estamos falando do ângulo formado entre o sacro e cabeça do fêmur, chamado ângulo de incidência pélvica, ele determina o equilíbrio entre o quadril e a coluna vertebral.

Uma coluna normal tem quatro curvaturas importantes, e para ter uma boa postura, é necessário que estas curvaturas sejam sempre preservadas.

  • Projetada um pouco para frente;
  • Uma curvatura torácica projetada para trás;
  • Uma curvatura lombar projetada para frente;
  • A curvatura do sacro projetada para trás.

Os discos intervertebrais

Os discos são estruturas cartilaginosas de pouca vascularização (circulação sanguínea). Eles variam de tamanho, de espessura e de formato; ou seja, suas características variam de acordo com o segmento vertebral. É a estrutura mais afetada da coluna vertebral e a que tem provocado grandes prejuízos para o homem moderno. Os 23 discos estão localizados entre as vértebras. Eles se conectam com as vértebras por meio das placas terminais. Essas placas têm um papel fundamental com o envelhecimento e o desgaste dos discos e vértebras. Portanto, conhecendo esse processo evolutivo, poderemos prevenir muitas dores nas costas. Os discos formam cerca de 25% do comprimento total da coluna. Por isso, o envelhecimento e a desidratação dessas estruturas anatômicas irão provocar diminuição na estatura dos idosos.

O disco é constituído na sua periferia por um anel fibroso e, na sua parte interna, por uma estrutura ”gelatinosa” chamada de núcleo pulposo. O grande desafio para nós, profissionais da saúde, é saber como prevenir lesões e desgastes nessa estrutura nobre do nosso corpo. Sabemos que a coluna vertebral e seus discos têm como função primária proteger a medula espinhal e suas raízes, e esses desgastes poderão levar a compressões e atritos nessa estrutura neurológica provocando dores e incapacidades indesejadas.

A medula espinhal

A medula é uma estrutura cilíndrica que fica dentro do canal vertebral. Ela é a porção alongada do nosso encéfalo. O seu início ocorre entre o crânio e a primeira vértebra cervical e se estende até a primeira ou segunda vértebra lombar. O comprimento pode chegar a 46 centímetros. Na sequência ou depois da segunda vértebra lombar, ela se ramifica – essas ramificações são chamadas de cauda equina.

Você também vai observar que a medula dá origem a vários pares de nervos, que são no total de 31. Esses nervos saem da coluna vertebral por meio dos orifícios formados entre uma vértebra e outra, também chamados de orifício de conjugação. Por intermédio desses nervos, a medula conduz os impulsos nervosos e exerce funções importantes sobre os músculos, proporcionando os movimentos.

A medula é envolvida por três membranas que também protegem o encéfalo. São elas: dura-máter, aracnoide e pia-máter, também chamada de meninges. Dentro dessas membranas encontramos líquido cefalorraquidiano, que banha todo o sistema nervoso. Por meio desse líquido, alguns diagnósticos poderão ser efetuados como: meningite, tumores etc. Agora que você entendeu as formas e as estruturas da coluna, os detalhes das vértebras e dos seus discos intervertebrais, ficou fácil perceber que toda essa complexidade anatômica tem uma função primordial, que é proteger a medula espinhal. Tudo foi feito nesse sentido, assim como a caixa craniana protege o nosso cérebro, nós precisávamos de um “tubo” protetor que protegesse a nossa medula espinhal de traumas e compressões.

Os ligamentos

Vamos entender agora outra função da coluna vertebral – a de realizar os mais diversos movimentos. Os ligamentos são pequenas estruturas formadas de tecido fibroso que unem um ou mais ossos, dando segurança e estabilidade. Na coluna, eles unem uma vértebra com a outra fazendo parte do conjunto de estruturas que dão estabilidade. Essas estruturas são estáticas; elas não se contraem ou se movimentam de forma voluntária.

Os ligamentos não têm a capacidade de se contrair partindo de um comando nosso, assim como fazemos com os músculos. Nós não temos controle sobre eles. Por isso, escutamos muito as pessoas falarem que foram operadas de ligamento, pois, uma vez que ele é rompido, dependendo da articulação que ele protege ou estabiliza e do grau da lesão, provavelmente será necessária uma intervenção cirúrgica para que ele volte a proteger e a estabilizar a articulação. Esse fato é muito comum com os ligamentos do joelho, do tornozelo e do ombro.

Principais ligamentos da coluna

  • Longitudinal anterior
  • Longitudinal posterior
  • Esternocostal intra-articular
  • Costotransversal lateral
  • Costotransversal superior
  • Intertransversal
  • Radiado

Músculos

Para entendermos os movimentos que a coluna vertebral realiza, devemos entender a participação dos músculos, como eles se comportam durante o nosso dia a dia e, principalmente, durante as lesões e as dores. Nesse sentido, existem muitos estudos que comprovam que esses músculos ficam fracos e atrofiados após os primeiros episódios de dores e lesões na coluna vertebral.

Nós temos dois tipos de músculos, basicamente, que agem sobre a coluna vertebral, os mais profundos e os mais superficiais, como também os mais distantes da coluna, que também têm influência na estabilidade. Assim como as pesquisas e suas evidências pontuam o fortalecimento muscular como um dos principais caminhos para manter uma coluna saudável, acreditamos também que um bom trabalho muscular poderá prevenir e remediar o homem dessa epidemia chamada hérnia de disco. O nosso objetivo é fazer com que você tenha a consciência de como os músculos das costas ficam fracos e sem resistência após ou durante as lesões, assim como, em geral, as pessoas têm essa consciência com os músculos das pernas e dos braços.

Importância de fortalecer os músculos

Quase todos nós sabemos mensurar quando os músculos do tríceps (aquele conhecido como “músculo do tchau”) estão fracos ou quando a coxa está atrofiada ou fina. É preciso que você entenda que, quando existe ou existiu dor na coluna, ali também se inicia ou se iniciou um processo de atrofia e fraqueza muscular. Dessa forma, essa atrofia ou perda de força não se recupera com a melhora da dor ou dos sintomas. Ou seja, uma vez iniciados os sintomas de dores nas costas, consequentemente começarão as atrofias e as fraquezas musculares. A única maneira de reverter esse quadro é com exercícios específicos para os músculos que protegem a coluna, principalmente os mais profundos e curtos, que são os multífidos.

Músculos multífidos

Os músculos mais profundos, também chamados de multífidos, são os responsáveis por boa parte da estabilidade da coluna. As suas características, os formatos e principalmente a sua fisiologia propiciam uma boa fixação e amarração da coluna vertebral. Esses músculos são curtos, realizam em média um ou dois movimentos ao mesmo tempo e as suas fibras musculares são mistas – ou seja, têm mais de uma função. Elas podem realizar movimentos rápidos e forçados e, ao mesmo tempo, são muito resistentes. Outra característica importante é que essas fibras demoram a se fadigar.

Esses pequenos músculos nos ajudam na manutenção da postura por longos períodos. Além de promover a extensão do tronco, esse músculo proporciona estabilidade posterior para coluna vertebral, nos mantém na posição de pé e é importante para realizar a flexão de tronco. Outros músculos profundos, como os intertransversais, interespinhais, rotadores, paravertebrais e eretores, contribuem com a geração de suporte para a coluna vertebral, mantêm a rigidez e produzem movimentos mais finos no segmento móvel.

Dinâmica de funcionamento

O importante é que você saiba que existem esses músculos nas partes mais profundas da coluna e que eles devem ser trabalhados e fortalecidos, assim como os músculos externos que nós podemos ver e palpar. Além disso, você precisa compreender que, quando os músculos profundos se atrofiam, o corpo solicita que outros músculos entrem em ação para suprir a deficiência dos que ficaram fracos. Aí, entram os músculos superficiais, também chamados de dinâmicos. São músculos longos e largos, tendo como função principal realizar os movimentos do nosso corpo.

Ao contrário dos músculos profundos, eles se fatigam e se cansam com facilidade. Portanto, podemos concluir rapidamente que os músculos da dinâmica não poderão substituir os músculos estáticos (profundos), e, quando isso, ocorre provavelmente teremos dores nas costas. Se os músculos dinâmicos (longos e superficiais) tentam substituir os estáticos (curtos e profundos) e não conseguem, por ficarem fatigados, isso significa que eles ficarão em espasmo, tensos, endurecidos, com pouca circulação sanguínea, em estado de tensão e dor.

É preciso deixar claro que as consequências desses músculos trabalhando constantemente em espasmos e contrações involuntária serão catastróficas para as vértebras e os discos. Eles agem no sentido de comprimir os segmentos vertebrais, provocando dores e sequelas irreversíveis.

Parte interna da coluna

Já é possível observar que a parte interna da coluna é muito rica de tecido nervoso, de cartilagem, de tecido fibroso, de ligamentos e músculos. Porém, não conseguimos ver nem palpar. Também podemos perceber que as articulações da coluna são diferentes das outras, principalmente das grandes como ombro, joelho, tornozelo etc. Primeiro, são vários ossos empilhados. Depois, encontramos várias “juntas”, com possibilidade de movimentos associados e variados que são guiados e executados por um emaranhado de cápsula, ligamentos, tendões e músculos.

Sendo assim, temos que ser imperativos no que diz respeito ao fortalecimento dos músculos das costas: devemos fortalecer os músculos profundos e próximos da coluna, como também os externos. Sendo assim, temos duas frentes de trabalho: uma mais simples, que é fortalecer os grandes músculos externos, que facilmente são trabalhados nas salas de musculação e pilates, mas, em grande parte, sem critérios técnicos para as pessoas que sofrem ou sofreram de dores nas costas. Se esses grandes músculos estiverem em estado de tensão ou em espasmo, eles não devem ser trabalhados e muito menos fortalecidos. O correto é indicar para uma reeducação postural no intuito de devolver o equilíbrio pélvico e de relaxar músculos e fáscias.

Além disso, outro grande problema é a segunda frente de trabalho, ou melhor, a técnica para fortalecer os músculos mais internos. É preciso a pessoa passar por uma escala de aprendizado, realizar algumas sessões de treinamento individual para primeiro identificar esses músculos, conseguir senti-los, perceber como são ativados e, em seguida, aprender a fortalecê-los. A população portadora de dores nas costas deve sempre solicitar dos seus fisioterapeutas e profissionais de educação física esse programa de treinamento.

O corpo humano

Na engenharia e nas obras da construção civil, toda coluna precisa de uma sapata, de um alicerce. Essa estrutura deve ser reforçada para receber a carga da casa ou do prédio. No corpo humano, não é diferente. A “sapata” da coluna vertebral é o nosso sacro, a bacia – com uma grande diferença: nós temos vida, nós nos movimentamos.

Portanto, a nossa “sapata” necessita de “fios” e ”cabos” que controlem e estabilizem as nossas infinitas variações de movimentos. Estamos falando dos músculos, tendões e ligamentos que cercam a nossa bacia, o nosso sacro, principalmente os músculos transversais, como foi visto antes. Fortalecer esse conjunto de músculos que envolve o sacro e o quadril é um grande desafio, pois a forma como eles são exercitados poderá ter ações benéficas ou catastróficas.

Ou seja, poderá gerar estabilidade ou dores por meio de compressões na coluna vertebral. Dependendo da posição ou do aparelho em que executamos determinados exercícios, a ação muscular será compressiva, ela poderá fazer uma aproximação de uma vértebra contra a outra, gerando, assim, pressões nos discos e articulações. Isso acontece quando não estamos bem posturados para fazer algum exercício físico ou mesmo para realizarmos tarefas do nosso dia a dia.

O que queremos mostrar para a população é que existe na coluna vertebral uma série de compartimentos e de músculos que obrigatoriamente temos de reabilitar e fortalecer de forma específica para termos uma coluna saudável. Para isso, os músculos exigem um grau de cuidado especial. Desta forma eles poderão dar uma boa resposta para o que queremos. É preciso ter muito critério na escolha da academia, do estúdio de pilates, empresa ou profissional que irá realizar o diagnóstico, a avaliação ou orientação dos seus exercícios. É muito comum ouvirmos de pacientes que tiveram dores e crises oriundas de exercícios mal elaborados em academias, salas de treinamento funcional e estúdio de pilates. Por isso, vale lembrar: o mais importante tratamento para doenças degenerativas da coluna é o programa de fortalecimento muscular e de manutenção dos exercícios.

Tratamento não cirúrgico para a Coluna Vertebral

O ITC Vertebral desenvolveu uma técnica de tratamento para a coluna vertebral sem procedimentos invasivos. Os pacientes são tratados de acordo com os sintomas e sinais da dor. Então 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

O ITC Vertebral incorporou a devida pesquisa ao trabalho clínico e acrescentou 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 em virtude de um 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 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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