Fatores de risco para tendinopatia patelar relacionados à cadeia cinética: estado da arte e protocolo de intervenção considerando potenciais fatores causadores de sobrecarga

• Ano de defesa: 2020
• Autor(a) principal: Pinto, Natã Ramalho
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Rio Grande do Norte; Brasil; UFRN; PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DA REABILITAÇÃO
• Palavras-chave em Português: Joelho de saltador; Aterrissagem; Fortalecimento; Flexibilidade; Salto
• Link de acesso: https://repositorio.ufrn.br/handle/123456789/31839

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.