Manipolazioni vertebrali
Fisioterapia e Osteopatia a Brescia
Nel vasto campo della terapia manuale, un ruolo di rilievo è indubbiamente ricoperto dalle manipolazioni, siano esse dirette alla colonna o alle articolazioni periferiche. Le manipolazioni, per intenderci sono quelle che (a volte) “scrocchiano”. Questa tecnica è un intervento comune a diverse professioni che si occupano della salute del sistema muscolo scheletrico: fanno parte infatti del bagaglio di fisioterapisti ed osteopati, seppur impiegate con razionali differenti, e costituiscono la base fondamentale del trattamento chiropratico nella sua versione più “tradizionale”.
Ma di preciso in cosa consiste una manipolazione, e a cosa serve esattamente? Rispetto ad altre tecniche dirette sulle articolazioni, definite mobilizzazioni, che sono di natura oscillatoria e ritmica, coprendo buona parte dell’arco di movimento articolare, le manipolazioni si distinguono per la velocità della tecnica e per la sua ampiezza estremamente ridotta, in una zona di minimo “gioco” articolare. Questo tipo di intervento, per ragioni ancora non del tutto chiare, può avere come risultato un rumore definito in letteratura cavitazione, cioè il “crack”, come quando si scrocchiano le dita. L’obiettivo dell’intervento manipolativo è come in gran parte delle terapie manuali quello di ridurre la sintomatologia dolorosa.
Ma come funziona?
È importante capire che la presenza di un rumore articolare non implica il riposizionamento di un osso: l’unico caso in cui un osso si sposta dalla sua sede articolare è quello di una lussazione o di una frattura, e in quei casi non è certo una tecnica di questo tipo il trattamento indicato. Da un punto di vista meccanico, l’effetto della manipolazione potrebbe essere soprattutto quello di indurre per via riflessa una diminuzione della rigidità muscolare, ma anche in questo caso si potrà avere chiarezza cono maggiori ricerche a riguardo. Le prime teorie su cui questo intervento era basato, secondo cui sarebbe necessario sistemare dei segmenti iin posizione non ottimale per migliorare la meccanica, sono quindi attualmente non supportate dalla scienza.
Buona parte dell’effetto analgesico della manipolazione è probabilmente legato a effetti di tipo neurofisiologico: questo significa che le “informazioni” ricevute dalla articolazione manipolata attivano una serie di meccanismi ormonali e influenza l’eccitabilità di alcune fibre nervose pe un lasso di tempo limitato e variabile, in cui si può verificare una ipo/analgesia.
L’assenza di una necessità di cambiamenti meccanici e la natura transitoria dell’effetto di queste tecniche ha come ovvia e giusta conseguenza il ridimensionamento della loro importanza nel trattamento di qualsivoglia condizione clinica: vanno interpretate, spigate ed utilizzate come un modo accessorio per ridurre i sintomi, e non sono una cura.
E in termini di sicurezza come siamo messi?
Da un punto di vista di sicurezza le manipolazioni vertebrali hanno dei rischi notevolmente bassi: le forze in gioco in una manipolazione ben effettuata sono in realtà ridotte, e non sufficienti a causare danni nei casi in cui queste siano un intervento non controindicato, come in casi di sospetta frattura, tumori o altre patologie importanti, in cui comunque compito del fisioterapista è riferire il paziente al medico adeguato. Compito del fisioterapista che ne fa uso è primariamente proprio quello di identificare l’adeguatezza dell’intervento alla problematica del paziente, in base ai sintomi ed alla storia della loro insorgenza. Nello specifico le manipolazioni cervicali, che fanno più “paura” sono anche esse un intervento che se applicato in pazienti selezionati correttamente, non rappresentano un rischio.
Come vengono inserite in un trattamento?
La manipolazione è un intervento che abbiamo visto avere come effetto la riduzione temporanea del dolore. Tenendo conto del fatto che gran parte dei disturbi per cui vengono impiegate, come episodi acuti di mal di schiena o mal di collo hanno la tendenza a risolversi in maniera positiva, vanno interpretate come un modo per poter gestire i sintomi in un piano terapeutico che comprenda esercizi per mantenere e migliorare le capacità motorie per la durata dell’episodio doloroso.
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what are androgens (Gerardo)
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Steroids And Fat Loss