Fatores de risco para tendinopatia patelar relacionados à cadeia cinética: estado da arte e protocolo de intervenção considerando potenciais fatores causadores de sobrecarga
Introduction: Patellar tendinopathy is one of the most common causes of anterior knee pain in athletes, described as a degenerative dysfunction in the patellar tendon, which results in pain located in or near the tendon insertions. Interventions for the treatment of this condition have traditiona...
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| Formato: | Dissertação |
| Idioma: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/31839 |
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| Resumo: | Introduction: Patellar tendinopathy is one of the most common causes of anterior knee pain
in athletes, described as a degenerative dysfunction in the patellar tendon, which results in
pain located in or near the tendon insertions. Interventions for the treatment of this condition
have traditionally focused on progressive exercises for the quadriceps, such as Alfredson's
eccentric protocol or the heavy-slow resistance training (HSR). Criticisms to these
traditional treatments emphasize that these interventions emphasize only the application of
progressive loads to the patellar tendon, but do not take into account risk factors/associated
factors that have contributed to patellar tendon overload. Objectives: The objectives of this
dissertation were: 1) to identify risk factors and factors associated with patellar
tendinopathy, in order to synthesize modifiable factors that may be important for the
management of this condition (1st study) and; 2) To propose an intervention protocol aimed
at factors of the kinetic chain (addressing factors of the hip, knee and ankle joints) in
comparison to the HSR protocol on pain, severity of symptoms and function, lower limb
strength and flexibility and jump landing mechanics in athletes with patellar tendinopathy
(2nd study). Methods: For the 1st study, a search was performed in the PubMed/MEDLINE,
Web of Science, Scopus, LILACS and CINAHL databases. The 2nd study is a protocol of
randomized double-blind clinical trial in which 28 male recreational athletes with patellar
tendinopathy will be recruited, divided into 2 groups: Heavy-Slow Resistance Training
(GTLAC; n=14), which will be treated by the protocol known as HSR; and the Kinetic
Chain Group (GCC; n=14) which will be treated with strengthening of hip extensors, knee
extensors and plantar ankle flexors, mobilization and stretching to improve ankle
dorsiflexion, in addition to a jump landing training, aimed to improve the dissipation of
forces in all joints of the lower limb during landing. Results: Thirty articles were identified
as eligible by the search strategy and were included for qualitative synthesis (5 longitudinal
and 25 cross-sectional). The results of prospective studies show that smaller flexibility in
the quadriceps and hamstrings, smaller range of motion of ankle dorsiflexion, better
performance in jumping with counter movement, a stiffer jump landing and higher
frequency of jumps are risk factors for patellar tendinopathy. Regarding the cross-sectional
studies, the results indicate that smaller hip muscle strength, a stiffer jump landing, less
ankle dorsiflexion range of motion, greater subtalar pronation and less hamstrings flexibility
are factors associated with patellar tendinopathy. Conclusion: Bearing in mind the
multifactorial nature of patellar tendinopathy, kinetic chain risk factors and associated
factors may be important aspects to be considered for the rehabilitation and potentially
prevention of this condition. It is expected that, with the conclusion of the clinical trial of
the present protocol, a greater understanding can be obtained on the effects of an
intervention aimed at addressing factors causing knee overload in athletes with patellar
tendinopathy. |
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