Aspectos biomecânicos integrados de ombro, coluna vertebral e quadril em indivíduos com e sem dor crônica no ombro

Abstract

Shoulder pain is a multifactorial origin symptom that may be related to structures that are part of the kinetic chain. The general objective of this thesis is to analyze the relationships between the shoulder and the kinetic chain referring to joint mobility, muscular endurance and neuromuscular control of individuals with and without shoulder pain. The study included 102 sedentary or irregularly active individuals (51 with and 51 without shoulder pain). The range of motion (ROM) and the time of muscular resistance of the cervical, thoracolumbar and hip spine, and the neuromuscular control of the lower limbs were evaluated using the Star Excursion Balance Test - SEBT. The results are presented in three studies: 1 - Motor alterations in the kinetic chain in individuals with chronic shoulder pain; 2 - Evaluation of joint mobility and muscle resistance of the cervical spine and its discriminative capacity for shoulder pain; and 3 - Factors related to resistance of periscapular muscles in shoulder pain. Study 1 found that, in general, individuals with shoulder pain presented a lower ROM in all movements evaluated, reduced resistance time of the thoracolumbar and hip spine muscles; and lower neuromuscular control of the lower limbs on the ipsilateral and contralateral sides to pain. A greater pain perception was observed in individuals with pain during all evaluations of ROM and muscle endurance. In addition, neuromuscular control in the anterior range of the limb contralateral to the painful shoulder presented excellent ability to discriminate individuals with shoulder pain. In study 2, a reduction in ROM and resistance time of cervical spine muscles was observed, with increased pain perception of the evaluated regions. Mobility in contralateral cervical flexion and rotation and resistance of ipsilateral lateral flexors demonstrate acceptable ability to discriminate individuals with shoulder pain. In study 3, a positive correlation was observed between the resistance of the periscapular muscles and kinetic chain muscles (spine and hip). The resistance of cervical extensors, thoracolumbar extensors, bilateral hip abductors, and contralateral hip extensors to shoulder pain explained the variation in resistance of the periscapular muscles. Age, time and intensity of pain, shoulder function and resistance of thoracolumbar lateral flexors and flexors did not present significant correlation with resistance of periscapular muscles. Our results show the importance of analyze the elements of the kinetic chain in the physical therapy approach of individuals with chronic shoulder pain, determining that factors such as central sensitization and regional interdependence may interfere in these biomechanical interrelationships.