O QUE É HÉRNIA DE DISCO ?

fisioterapeuta examinando paciente com hérnia de disco
A hérnia de disco é uma lesão que ocorre com mais frequência na região lombar. Essa doença é a que mais provoca dores nas costas e alterações de sensibilidade para coxa, perna e pé. Aproximadamente 80% das pessoas vão experimentar a dor lombar em algum momento de suas vidas. A localização mais comum da hérnia de disco lombar é no disco que fica entre a quarta e quinta vértebra lombar (L4/L5) e no disco que fica entre a quinta vértebra e o sacro (L5/S1).

Na maioria dos casos, os sintomas da hérnia de disco melhoram naturalmente com três meses, mas isso pode ser diferente se forem auxiliados com tratamentos clínicos e fisioterapêuticos. Mesmo o paciente se sentindo bem sem tratamento, é importante que ele faça um programa voltado para a funcionalidade normal da coluna e para o seu fortalecimento. As pesquisas são categóricas: após os primeiros sintomas de dores nas costas, os músculos que protegem a coluna vertebral começam a ficar fracos e atrofiados.

A população precisa saber que essa doença não tem cura, mas as pessoas podem melhorar da dor e voltar a ter uma vida normal, mas é bom deixar claro que o repouso e os medicamentos não devolvem a funcionalidade nem fortalecem os músculos que ficaram fracos com a doença, o que nós acreditamos ser um dos principais motivos de tantas dores recorrentes na coluna vertebral. Então, se você teve um episódio de dor severa na coluna e esses sintomas permaneceram por mais de três meses, provavelmente outros virão. Essa regra vale para 100% dos casos.

SURGIMENTO DA HÉRNIA DE DISCO


A palavra “hérnia” quer dizer projeção ou saída por meio de uma fissura ou orifício de uma estrutura contida, ou seja, o disco intervertebral é uma estrutura fibrosa e cartilaginosa que contém um líquido gelatinoso no seu centro, chamado núcleo pulposo. O disco fica entre uma vértebra e outra da coluna vertebral.

E esse anel fibroso, quando apresenta fissura ou está desgastado, permite que o líquido gelatinoso – que estava mantido no seu centro – realize uma expansão ou abaulamento da sua estrutura, podendo, também, extravasar. Quando esse fenômeno ocorre em pequenas proporções, chamamos protusão discal. E se a lesão no anel fibroso que mantém o núcleo for grande, o líquido contido no núcleo poderá sair para o meio externo e, quando isso acontece, o disco poderá diminuir de volume, achatando-se. Por isso, chamamos de hérnia de disco. Dependendo do local da saída desse “gel”, o paciente poderá sentir fortes dores ou não. Com esse conceito, fica claro que o importante é saber qual é a localização da hérnia de disco, e não o seu tamanho.

CAUSAS DA HÉRNIA DE DISCO


A palavra “coluna” já diz tudo sobre a importância desta estrutura no nosso corpo. Ela é o centro de equilíbrio do sistema musculoesquelético do ser humano e fornece a base para a estabilização do nosso corpo, permitindo uma distribuição perfeita das forças e dos gestos exercidos no nosso dia a dia ou nas práticas esportivas. Não é à toa que muitas lesões da coluna vertebral são atribuídas ao desequilíbrio e ao desalinhamento desta estrutura. Ou seja, a má postura é, sem dúvidas, a grande vilã dos males de coluna.

Existe uma postura correta para qualquer movimento que realizamos, inclusive, quando estamos em posição estática. Com a correria do dia a dia, nem sempre é possível obedecer a todas as regras, mas, ainda assim, podemos adotar o máximo de cuidado para não sobrecarregar os nossos músculos e articulações.

TIPOS DE HÉRNIA DE DISCO:


> Protrusas: O disco se alarga, mas contém o líquido gelatinoso no seu centro. A base do disco se avoluma e fica mais larga que o diâmetro de origem. As paredes do disco poderão tocar em regiões e áreas de grande sensibilidade nervosa, gerando dores e incapacidades.

> Extrusas: A hérnia de disco lombar extrusa é uma condição ortopédica muito frequente e importante que afeta os discos intervertebrais da coluna, que funcionam como verdadeiros amortecedores. A patologia se dá quando há o rompimento desse anel fibroso e o conteúdo gelatinoso interno, ou núcleo pulposo, sai por meio de uma fissura na membrana, havendo perda de contato dos fragmentos extravasados com o seu meio interno.

> Sequestradas: A hérnia de disco sequestrada é aquela que rompe a parede do disco e o líquido gelatinoso migra para dentro do canal medular, para cima ou para baixo. Além da pressão na raiz nervosa, provoca inflamação e compressão contínua. É o tipo de hérnia que provoca a chamada dor química, pois esse núcleo pulposo, quando fora do seu ambiente natural, tem propriedades químicas ácidas e provoca dores insuportáveis. O paciente se apresenta com postura antálgica, inclinando o tronco para o lado que lhe dê conforto. Neste caso, a melhora só será possível com medicamentos, repouso ou até mesmo cirurgia.

Manter a postura correta não é importante apenas para a boa aparência, alterações posturais desde a infância, por exemplo, já predispõe problemas na vida adulta. Daí a necessidade de prevenir hábitos incorretos de postura. Veja, a seguir.

COMO CORRIGIR A POSTURA


O importante é jamais forçar apenas uma parte do corpo, os ossos têm que suportar pesos iguais. Quando você senta, por exemplo, nunca deve apoiar o peso somente em uma perna, deixando a outra solta. É fundamental o aprendizado do não desperdício de energia durante a execução de movimentos ou em posição estática, distribuindo o peso do corpo de forma equilibrada. Algumas dicas para evitar problemas posturais:

ATIVIDADES DOMÉSTICAS


Na realização de atividades domésticas, evite trabalhar com o tronco totalmente inclinado se estiver em pé; quando for passar roupa, a mesa deve ter uma altura suficiente para que a pessoa não se incline, outra dica é utilizar um apoio para os pés e alterná-los sempre que houver algum incômodo. Para calçar os sapatos não incline o corpo até o chão, sente-se e traga o pé até o joelho. Para se elevar um peso acima da altura da cabeça, deve-se apoiar o peso no corpo e subir em uma escada ou banquinho para depositá-lo adequadamente. Quando for erguer um peso, deve-se abaixar flexionando os joelhos até embaixo sem curvar a coluna, levantar-se transferindo a carga para os músculos das pernas que são mais fortes do que os da coluna, caso seja possível coloque o objeto em um carrinho e empurre.

AO DORMIR

Na hora de dormir também são necessários cuidados como escolher um bom colchão semi-rígido ou de espuma para distribuir bem o peso do corpo, um bom travesseiro e adotar algumas posturas corretas na cama. Se você costuma dormir de barriga para cima utilize um travesseiro embaixo dos joelhos; ao dormir de lado, um travesseiro entre as pernas que devem estar dobradas. Dormir de bruços não é recomendado, mas se você não consegue de outro jeito utilize um travesseiro embaixo da barriga e não da cabeça, diminuindo a curvatura lombar.

AO SENTAR

Sentar corretamente também é muito importante para uma boa postura. Procure manter os pés apoiados no chão; coxas tocando suavemente a maior área possível do assento; evite cruzar as pernas e deixe-as ligeiramente afastadas; a coluna deve ser mantida ereta, de forma a preservar suas curvas naturais (encoste as costas completamente no sofá ou na cadeira, evitando esparramar-se). Manter a coluna ereta é sempre melhor do que deixá-la inclinada em qualquer situação. Adotar uma postura correta para sentar evita dor nas costas e sérias lesões na coluna vertebral. Quando se senta da maneira apropriada há uma distribuição uniforme das pressões sobre os discos intervertebrais e os ligamentos e os músculos trabalham em harmonia, evitando desgastes desnecessários.

AO TRABALHAR

No trabalho também é importante adotar posturas menos prejudiciais. Se você trabalha sentado, os seus braços devem ficar pendidos ao longo do corpo ou os antebraços apoiados na mesa de trabalho. Evite torções de corpo inteiro, levante-se ou use uma cadeira apropriada que gire com facilidade para pegar algo, falar com alguém ou jogar papel no lixo. Caso trabalhe com computador, procure regular a tela de modo que a borda superior fique na altura do olhar para o horizonte, mantenha o queixo paralelo ao chão. Para ler, evite ao máximo ter que baixar a cabeça, se for preciso adquira um suporte de livros.

Descubra os outros fatores que, além da má postura, podem ser prejudiciais:

  • Fatores hereditários;
  • Traumas diretos ou de repetição;
  • Fumo;
  • Idade avançada (também é motivo de lesões degenerativas);
  • Sedentarismo (é um fator determinante para dores nas costas);
  • Ação de inclinar e girar o tronco frequentemente;
  • Posição de ficar em pé ou sentado por muito tempo, principalmente no trabalho;
  • Ação de levantar, empurrar e puxar objetos;
  • Movimentos repetitivos em casa ou no trabalho;
  • Prática esportiva;
  • Trabalho que provoca vibrações no corpo;
  • Trabalhar dirigindo;
  • Fletir o tronco com frequência para apanhar objetos;
  • Fatores psicológicos e psicossociais.

SINTOMAS DA HÉRNIA DE DISCO


Os sintomas mais comuns são dores localizadas nas regiões onde existe a lesão do disco. Essas dores podem ser irradiadas para outras partes do corpo.

Quando a hérnia é na coluna cervical, as dores ou as alterações de sensibilidade se irradiam para as regiões superiores dos ombros, para os braços, as mãos e os dedos. Se a hérnia de disco é lombar, as dores se irradiam para as pernas e pés, e o paciente pode também sentir formigamento, dormência, ardência e dores na parte interna da coxa. As pessoas relatam que é uma “dor chata” e que não existe posição que melhore. Alguns relatam que ela piora quando vão dormir. Isso acontece porque, nesse momento, o corpo fica relaxado e os discos se reidratam, aumentando o seu volume e, consequentemente, comprimem as raízes nervosas. Nos casos mais graves, a compressão poderá causar perda de força nas pernas e até mesmo incontinência urinária.

PRINCIPAIS SINTOMAS

  • Dor nas costas há mais de três meses;
  • Coluna torta quando entra em crise;
  • Dor noturna que piora durante o sono e que permanece ao acordar;
  • Dor que piora ao ficar em pé com a perna estendida;
  • Bastante dificuldade para ficar sentado por mais de 10 minutos;
  • Redução de força em uma das pernas ou nas duas;
  • Impossibilidade de ficar de ponta de fé com uma das pernas;
  • Dor, formigamento ou dormência nos membros;
  • Dificuldades extremas para segurar a urina;
  • Redução do rendimento e desânimo para a realização de atividades rotineiras;
  • Dores de cabeça associadas a dores na região da nuca e que se prolongam para os ombros;
  • Dificuldades para se locomover ou levantar algum objeto.

Qualquer um desses sintomas representa um sério problema para sua coluna vertebral. Não tome remédios por conta própria e nem espere que sua dor melhore sozinha. Mas nenhum tipo de dor na coluna deve ser ignorado, principalmente quando o paciente detecta a presença de um ou mais dos sintomas listados acima. Ao identificar esses sintomas, deve-se procurar por ajuda médica imediatamente. Mascarar a dor com o uso de medicamentos (por conta própria) ou “receitas caseiras” é colocar a saúde em risco.

DIAGNÓSTICO DA HÉRNIA DE DISCO

O diagnóstico pode ser feito clinicamente, levando-se em conta o histórico do paciente, as características dos sintomas e o resultado do exame físico realizado durante a avaliação. As regiões mais comuns de serem acometidas com hérnia de disco são a coluna lombar e a coluna cervical.

Quando as pessoas procuram por um profissional com queixas de dores no pescoço, exploramos inicialmente a possibilidade de existir alguma assimetria facial, observamos o tipo de mordida e analisamos se o comportamento do paciente tem características de ansiedade ou estresse. Esses fatores contribuem para o aparecimento de dores na coluna cervical e até mesmo da hérnia de disco.

EXAMES

Os exames como raio X, tomografia e ressonância magnética ajudam a determinar o tamanho da lesão e a localizar em que exata região da coluna está a lesão, mas eles não são decisivos para a tomada de conduta.

O exame mais importante e decisivo é o que realizamos com o paciente: ouvir o que ele tem para nos falar sobre a dor, procurar saber o que ele faz no dia a dia em casa e no trabalho e entender as reações do corpo. Todos esses detalhes poderão dar uma grande contribuição para melhora do paciente, e cabe ao profissional ficar atento. A falta de atenção com o paciente é um dos fatores de negligência das condutas dos profissionais de saúde. O cuidado e a atenção com os nossos pacientes são imperativos.

O mais importante é que hoje nós temos excelentes alternativas de tratamento sem cirurgia. A população deve ter consciência desses novos conceitos de tratamento e não aceitar a primeira proposta de condutas invasivas. Existem médicos que estão exigindo que o paciente assine um longo contrato antes dos procedimentos. Tudo isso para o médico se precaver das futuras reclamações ou processos judiciais. Parece até a confirmação do insucesso que vai existir com o procedimento. É importante que todos pesquisem e tenham mais cautela e paciência no momento de escolher o médico.

A IMPORTÂNCIA DO DIAGNÓSTICO EXATO

Pessoas com suspeita de hérnia de disco são diagnosticadas em, apenas, 1% a 5% dos casos com a patologia, isso, porque a maior parte não tem este problema, mas possuem outros problemas, como o famoso bico de papagaio, ou seja, a falência estrutural ou funcional dos discos intervertebrais.

Muitas vezes, o sintoma que o paciente acredita ser de determinada doença é, na verdade, decorrente de outro problema que pode ser de resolução mais simples – e também mais grave. Daí a necessidade de um diagnóstico exato e precoce. Nenhum paciente deve ser submetido a qualquer tratamento antes do primeiro passo (insubstituível): a avaliação. Um especialista deve realizar todos os procedimentos para identificar o problema a ser tratado, as necessidades específicas para o quadro daquele paciente e as limitações apresentadas pelo mesmo. Uma vez realizado esse passo inicial, o atendimento poderá ser direcionado ao paciente com uma maior garantia de resultados seguros através do tratamento.

COMO PREVENIR UMA HÉRNIA DE DISCO

Mudanças no estilo de vida são indispensáveis para evitar o surgimento da hérnia de disco. Dentre as orientações, podemos destacar:

  • Evitar o fumo;
  • Praticar atividades físicas sob orientação profissional para, sobretudo, fortalecer a musculatura de sustentação da coluna, tornando-a mais resistente aos possíveis impactos;
  • Adotar uma dieta saudável para controlar o peso corporal e prevenir que a coluna sofra com as sobrecargas;
  • Não carregar excesso de peso no dia-a-dia ou no trabalho;
  • Praticar exercícios de alongamento;
  • Manter uma postura adequada em todas as situações.

HÉRNIA DE DISCO COMO CAUSA DE APOSENTADORIA

A hérnia de disco é uma causa de radiculopatia, traduzida como qualquer doença que afete a raiz dos nervos espinhais. Ela tem alta incidência entre pessoas adultas jovens, o que não significa dizer que crianças e idosos estejam livres dessa afecção na coluna. Segundo dados do IBGE, a patologia atinge cerca de 5,4 milhões de brasileiros, podendo ou não apresentar sintomas e ocorrendo com maior frequência na região inferior das costas (lombar).

Para fins previdenciários, a impossibilidade de desempenho de atividades em decorrência de alterações patológicas ocasionadas por doenças ou acidentes é considerada como incapacidade laborativa. Desse modo, qualquer enfermidade pode ser geradora de incapacidade parcial ou total.

No Brasil, uma das causas mais comuns para as dores nas costas é o desenvolvimento da hérnia de disco. Os transtornos da coluna vertebral são responsáveis pela maior parte dos afastamentos no trabalho e auxílio-doença e grande parcela dos casos de aposentadoria precoce por invalidez. O comportamento sedentário da maioria da população tem contribuído bastante para o agravamento desta patologia, além de outros hábitos inadequados do dia a dia, como a má postura.

FUJA DO SEDENTARISMO

  • Prefira subir e descer escadas ao invés de usar o elevador ou a escada rolante;
  • Deixe o carro na garagem para percorrer pequenas distâncias, como, por exemplo, aquela ida à padaria;
  • No trabalho, tente levantar a cada meia hora e caminhar um pouco pelo ambiente – isto ajuda a evitar as dores;
  • Quem pega ônibus para voltar para casa pode descer uma parada antes e fazer o restante do trajeto a pé;
  • Pequenas tarefas domésticas, como fazer faxina, levar o cachorro para passear e arrumar a cama colaboram para colocar o corpo em movimento e evitar problemas futuros;
  • É importante praticar uma atividade física, pois o sedentarismo pode acarretar dores nas costas, em virtude do enfraquecimento muscular.

Entre em contato conosco!

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