Dolore alla spalla: l’utilità dell’esercizio nelle problematiche di cuffia dei rotatori.
Autore: Giacomo Zipponi
La famosa cuffia dei rotatori. La famosissima e irreprensibile cuffia di rotatori. I muscoli rotatori. Ma non sapevo si dovessero allenare per recuperare l’uso della spalla.
Questo è quello che immagino quando vedo un paziente sorpreso dalla proposta di fare degli esercizi per superare un episodio di dolore alla spalla.
Ma andiamo con ordine, chiariamo il perché della mia sorpresa.
Come è fatta una spalla
La spalla, e in questo caso per spalla intendiamo proprio l’articolazione principale, quella che tutti immaginano quando si parla di spalla, che in gergo tecnico si chiama gleno-omerale, è un’articolazione fra due superfici molto diverse. Spesso la pensiamo come una palla in una ciotola, ma in realtà assomiglia di più ad una pallina da golf su una moneta da 2 euro. Detta così diventa abbastanza chiaro quanta sia l’importanza dei legamenti e della muscolatura a fare si che il nostro braccio rimanga attaccato al nostro corpo. Nello specifico un grosso ruolo di stabilizzazione e movimento della spalla è rivestito da quel gruppo di muscoli che vengono chiamati nel loro insieme la cuffia dei rotatori.
Che non è questa …
… ma questa
Presentiamo gli attori: abbiamo due muscoli, sottospinato e piccolo rotondo, che si danno una mano a vicenda a extraruotare (se state con le mani dietro la testa e i gomiti larghi state extraruotando), uno grande e grosso, il sottoscapolare, che fa il lavoro opposto ai due, ovvero l’intrarotazione (se vi grattate a mezza schiena state intraruotando) e poi il sovraspinato: un piccoletto che sta lì sopra appeso, non rompe a nessuno e fa il suo lavoro di iniziare il sollevamento laterale del braccio (in gergo tecnico abduzione).
Spesso si pensa a questi muscoli come se fossero dei cavi che si attaccano su punti specifici dell’osso. In questo caso, se uno di questi si dovesse danneggiare o rompere del tutto si perderebbe completamente un certo movimento. In realtà, anche se questi muscoli fanno movimenti diversi, più si avvicinano alla spalla più si avvicinano fra loro e i loro tendini sono un guazzabuglio difficile da distinguere: più che vedere 4 tendini diversi si vede una specie di pellicola che avvolge completamente la spalla. Questo fa sì che, anche se uno di questi muscoli perde forza o si lesiona, spesso se gli altri diventano forti a sufficienza si riesce a recuperare una buona capacità di movimento per il braccio.
Cosa può capitare alla cuffia dei rotatori?
Osservando tramite ecografia o risonanza queste strutture si può vedere come se la passano: a volte si possono scoprire depositi di calcio dove non ci si aspetterebbe di vederli, come sui tendini, oppure scoprire delle lesioni di questa rete di tessuto connettivo, talvolta parziali e tlvolta a tutto spessore e talvolta massive. Vediamo di capire le differenze.
Per chiarire il più possibile possiamo pensare alla cuffia nella sua totalità come a un tappeto, o a un fazzoletto. Il tappeto rende di più l’idea di quanto siano robusti questi tendini a mio parere.
Una lesione parziale possiamo immaginarla come un tappeto che in un certo punto, ad esempio quello dove vostro figlio gioca sempre con le macchinine, risulta essere “liso”: il tendine in quel punto ha una parte di fibre che non lavorano normalmente o che hanno dato forfait, ma tutte quelle sotto sono ancora funzionanti.
Una lesione a tutto spessore è un buco nel tappeto, come quello che potrebbe farsi rovesciandoci sopra un acido che lo sciolga. In questo caso, in quel punto specifico nessuna fibra sta lavorando, perché le fibre proprio non ci sono. In compenso tutto attorno i tendini continuano a fare il loro lavoro. fortunatamente, al contrario di un tappeto, che deve essere bello da vedere, la cuffia dei rotatori anche con qualche buchetto può fare la sua bella figura, consentendo un movimento completo e funzionale della spalla.
Viene definita lesione massiva una lesione a tutto spessore che include più di due tendini della cuffia. In questo caso dobbiamo pensare a un tappeto con una porzione mancante abbastanza grande, e in una spalla questo può portare ad una notevole perdita di forza e di funzionalità.
Tutti questi tipi di lesione, classificati in base alle dimensioni, si possono presentare a seguito di traumi ma spesso sono visibili anche in soggetti che non hanno alcun dolore: in questi casi di solito la ragione è che i cambiamenti sono avvenuti lentamente nel tempo ed il corpo ha avuto modo di adattarsi a funzionare adeguatamente. Non dobbiamo dimenticare infatti che i nostri tendini, contrariamente ad un tappeto, sono vivi, e possono guarire spontaneamente, se viene dato loro il giusto carico. Inoltre come abbiamo detto prima, anche in presenza di lesione, una grande fetta di muscoli e fibre tendinee sono ancora in grado di fare il loro lavoro. Esistono studi che evidenziano come certi tipi di lesione, in soggetti che non hanno dolore, divengano molto frequenti con l’aumentare dell’età, quasi come se fossero segni di invecchiamento paragonabili ai capelli bianchi o alle rughe (che non fanno male se non all’orgoglio).
Quando il gioco si fa duro… SSMP
Nonostante la capacità di adattamento del nostro corpo, una spalla con una lesione (ma anche senza lesioni) Può fare male (pensatela come le persone: qualche persona brutta è anche cattiva, ma non tutte le persone cattive sono brutte, e non tutte le persone brutte sono cattive, insomma ci siamo capiti). In questi casi rivolgersi ad un professionista è utile per capire come gestire il recupero. Nella maggior parte dei casi l’intervento chirurgico non risulta necessario e una gestione conservativa, se ben costruita (e per ben costruita si intende con un attivo coinvolgimento del proprietario della spalla), è sufficiente ad ottenere risultati soddisfacenti.
Un ottimo punto di partenza, soprattutto in fasi acute in cui il dolore rappresenta il più grande ostacolo al movimento, è utilizzare una SSMP, sigla che sta per Shoulder Symptoms Modification Procedure, che in parole povere significa esplorare diversi modi di fare una azione dolorosa in modo che non lo sia più. Esercizi con piccoli elastici, modificazioni della posizione di partenza, assistenza al movimento offerta da terapista o da forza di gravità, bendaggi di vario tipo possono tornare utili in questa fase. Anche terapia manuale e strumentale possono aiutare a ridurre il dolore , ma hanno senso solo se accompagnate ad un frequente movimento, per far calmare il dolore associato alle posizioni che assumiamo. Le teorie dietro al perché determinate azioni intraprese per modificare i sintomi abbiano successo si sprecano, ma la verità è che non sappiamo esattamente come funzionino la maggior parte di queste strategie. Quello che sappiamo è che se ad esse si associa un programma di esercizio attivoi risultati sono migliori.
I duri iniziano a giocare.
Cosa si intende per programma di esercizi? Sono molte le forme di rinforzo, sia di tipo selettivo che globale attuabili per favorire il recupero. Alcuni esercizi di rinforzo possono essere iniziati molto presto, anche nella fase in cui il dolore è più presente, perché non vanno ad essere irritanti. Quali sono questi movimenti? Variano molto da caso a caso: per qualcuno potrebbero essere movimenti di rotazione, per altri movimenti in cui si tira o si spinge, in altri casi ancora può essere utile iniziare prendendo una strada un po’ più “larga”, iniziando dalle scapole o dalla colonna.
Vediamo di esplorare quali siano i benefici delle diverse forme di esercizio in situazioni di patologia della cuffia dei rotatori.
Attività aerobica non dolorosa.
Soprattutto in fasi iniziali di dolore abbastanza alto, il mantenere una regolare attività aerobica non provocativa può essere molto utile. Questa forma di esercizio ha infatti un effetto analgesico sistemico grazie alla sua azione metabolica. Se pensiamo ad esempio alla camminata o anche alla corsa (se non è irritante per la spalla), hanno un’azione di mobilizzazione leggera e ritmica delle spalle, che può stimolare una iniziale attività della muscolatura e ridurre la sensazione di rigidità spesso avvertita quando il dolore è presente.
Esercizi “lontani”.
Spesso nella SSMP che abbiamo visto prima sono coinvolte posizioni della colonna o delle scapole differenti da quelle abituali: iniziare ad allenare il controllo di queste parti del corpo permette di essere poi più efficaci nel modificare le proprie attività quotidiane, oltre che fornire una base migliore per il movimento della spalla quando invece si inizia il rinforzo.
Esercizi diretti di rotazione.
I muscoli della cuffia dei rotatori hanno azione stabilizzante durante tutti i movimenti della spalla, ma come dice il nome hanno anche il ruolo di fare i movimenti di rotazione. Per iniziare ad attivarla semplici spinte in rotazione mantenute possono essere una buona opzione, a cui poi far seguire rotazioni con un arco di movimento ed una velocità controllate, fino poi a ricercare anche contrazioni di tipo veloce e reattivo. Le posizioni in cui fare i diversi esercizi possono e devono variare per poter stimolare la spalla ed i muscoli in una varietà di angoli.
Spinta e tirata per tornare forti.
In un programma di rinforzo per la spalla movimenti di spinta e tirata su diversi piani e in diverse situazioni rappresentano gli esercizi principali con cui costruire forza per diverse ragioni. Innanzitutto sono movimenti spesso non provocativi o facilmente modificabili per essere resi non dolorosi; inoltre per una questione di leve, permettono di arrivare a sollevare, con il tempo ed una crescita graduale, carichi importanti, che hanno due effetti: 1- attivare molto la muscolatura e renderla effettivamente più forte, 2- da un punto di vista mentale, per qualcuno che faceva fatica a prendere la brocca dell’acqua, arrivare a sollevare qualche kg ha un effetto incoraggiante che non va sottovalutato. In futuro vedremo come questi esercizi possono essere suddivisi e classificati.
Movimenti a leva lunga.
Tipicamente sollevare il braccio tenendo il gomito disteso, frontalmente o lateralmente, è uno dei movimenti che in casi di problemi alla cuffia dei rotatori può risultare doloroso. Questo a causa del fatto che essendo la leva più lunga, la forza e la tensione su muscoli e tendini risulta più alta rispetto a spingere o tirare piegando il gomito, che come abbiamo visto prima è spesso meno doloroso. Questo non significa che tali movimenti vadano evitati, ma in u programma di rinforzo in cui sono i più sensibili sicuramente saranno trattati con un po’ di riguardo in più (inizialmente): possono essere ad esempio introdotti in maniera assistita o addirittura passiva, per poi andare a gestirli in posizioni vantaggiose in cui farli attivamente ma con un dolore tollerabile; infine anche su questi l’obiettivo ideale è quello di costruire un buon livello di forza.
Si ma tutta ‘sta roba quanto va avanti?
Risposta diretta, onesta e brutale: un buon programma di rinforzo in generale ha una durata attorno alle 12 settimane. Meno di 6 settimane significa fermarsi prima di avere ottenuto cambiamenti reali della forza. Questo non sta a significare che dovranno passere 3 mesi prima di non avere più dolore alla spalla: i sintomi infatti possono alleggerirsi molto più rapidamente. I 3 mesi sono il tempo necessario a ricostruire e forse anche migliorare gradualmente la capacità della spalla di gestire movimenti e carichi diversi. Sono inoltre un tempo utile per imparare ad autogestirsi negli esercizi e instaurare l’abitudine a tenersi in movimento, per imparare ad interpretare i segnali del nostro corpo.
L’obiettivo di un percorso di fisioterapia di questo tipo è quello di fornire al paziente gli strumenti e le conoscenze per fare sì che sia lui a guarire, non noi a guarirlo.
Autore: Giacomo Zipponi
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One of the perks of conventional Chinese herbs is that
the formulation may be custom-made for each affected person, all the
method down to the dosage and components, based mostly on the individual’s eczema condition. There are
more than 10,000 herbs used in TCM, which are mainly sourced within the leaves,
stems and roots of sure plants.
However keep in mind, it is not a magic tablet; it works finest when your food
regimen and workout are already on point. If you are seeking to fine-tune your
features and recovery, this could be the subsequent step.
Back in ‘ninety four, when the Dietary Supplement and Well Being Education Act (DSHEA) got here into play, DHEA stepped into the spotlight as a
steroid various. They are dietary supplements that replicate the effects of steroids without any
unwanted effects that you simply would not like. No,
supplements, principally closest things to steroids do not suppress hormones,
and thus post-cycle remedy is unnecessary.
Whereas analysis is ongoing, Tongkat Ali and Tribulus Terrestris are sometimes cited as potential choices for enhancing testosterone
ranges, which can not directly contribute to muscle growth.
Nonetheless, it’s necessary to notice
that particular person responses to those herbs can vary,
and scientific proof supporting their effectiveness remains to be restricted.
Administration to children and adolescents may
result in hormonal effects similar to those obtained upon the
cessation of bone growth in adults, early puberty, and pre-matures
[101]; see Figure 6C.
Creatine, an amino acid present in meals, is one other compound with steroid-like effects.
Studies have shown that using creatine for 5-7 days can considerably enhance performance
in actions requiring multiple sets of maximal-effort muscle contractions, such as sprinting and soccer.
It’s also a robust superfood containing 18 amino acids and over 200 nutritional vitamins,
minerals, and antioxidants. He or she will assist you
to pick an all-natural model and can record all the benefits and
side effects you would possibly encounter.
Zinc additionally performs an essential role in treating male sexual
dysfunction by regulating blood move to the prostate gland and helping to manage testosterone ranges.
If you’re already taking medicines, you want to discuss
to your physician earlier than starting taking any of the steroid alternate options.
Some doctors advocate anabolic steroids to patients who have suffered from injuries that have
resulted in scarring, or perhaps those that
have undergone surgery, radiation therapy, chemotherapy, or an operation.
In my expertise, curcumin (an extract of the spice turmeric) is the general most effective treatment.
It has been used efficiently for simply about
every inflammatory condition. The proof for this is piling up in revealed research from the world’s medical literature.
Other natural dietary supplements, such as protein powders, creatine,
and BCAAs, will not yield steroid-like results.
In contrast, we generally observe harm to the HPTA from a steroid
cycle, causing low endogenous testosterone levels for a number of
weeks or months after. Anecdotally, we have had bodybuilders report as much as 12 lbs
of muscle acquire, and others expertise no visible
outcomes.
Sometimes, will probably be stacked with Testosterone to boost
features if you’re on a lean bulking cycle at
this dose. In terms of muscle features, do not expect anything too cumbersome,
but lean muscle only. The steroid has a good effect on the
nitrogen retention, as properly as the protein synthesis.
For most effects, customers would need to increase the protein intake slightly.
I’ve seen males taking 2000mg and even 3000mg (you can start measuring in grams at that stage – for instance, 2g/week).
There is less danger of these unwanted effects occurring in any respect or occurring at a severe stage than there’s with other steroids that are rather more androgenic
than Boldenone. Nonetheless, it’s nonetheless necessary to
know that androgenic effects are potential in some users.
Androgenic effects are a extra serious concern for feminine
users of Equipoise, and virilization is an actual risk, particularly the place greater doses are taken. Androgenic side effects are one
other area that steroid users will be acquainted with, and once once more,
EQ is relatively gentle in this regard in comparison with many
different anabolic steroids. Nevertheless, those that have a genetic predisposition to
problems like acne or male sample baldness may see some exercise
in these areas. There will at all times be unfavorable feedback from females
who have used AAS and started to experience virilizing effects, and EQ is no exception.
Making An Attempt to drag off an extreme quantity of weight is
a standard mistake for model new gear customers. Using steroids will all be for nothing when you don’t get your diet and training right25.
Once More, this extremely depends on your targets and
why you’re doing a cycle. Bulking and cutting could have two very completely
different diets and workout methods. Steroid stacks mix two or
extra compounds so you possibly can combine their advantages and obtain greater results than using only one compound alone.
Newbie stacks could be simple, while superior customers can easily mix
three or extra compounds in a cycle. Hell, even beginners can begin with a simple stack with minimal
danger as long as the basics of dosage, cycle size, aspect
impact management, and PCT are followed.
There are other steroids stronger than Winstrol for enhancing
strength and muscle hypertrophy, similar to testosterone, trenbolone,
and Dianabol. Nonetheless, these steroids are more
and more likely to trigger virilization-related unwanted facet effects.
Winstrol isn’t a steroid that requires massive
doses to provide nice leads to girls as a result of it’s a powerful steroid (and girls naturally only have small amounts of
testosterone).
They also obtain a far higher degree of weight reduction assist and
don’t need to fret about unwanted effects.
Winstrol is another steroid for girls that causes unfavorable changes
in ldl cholesterol. It causes you to have much less of the
great sort and more of the unhealthy and also pushes up blood stress.
It’s not unreasonable to anticipate a fats loss of round three pounds per week while using Winstrol.
Girls who use this steroid can burn considerably more fats with it than they’d
with out it. That’s presuming they’re making the right efforts with food
regimen and exercise routine.
Of the two, I would contemplate Clen the higher muscle preserver and one that
gives you a greater minimize. You can’t use a potent drug like Clenbuterol and not have a lot of adverse feedback or complaints/concerns being shared.
Feminine users will usually be nicely aware of the downsides
of Clen, and frequent feedback about jitters, nervousness, and sleeping issue may be discovered.
As a strong stimulant, it shouldn’t come as a surprise that
Clen can lead to sleep difficulties, nevertheless it does make it important to no much less
than attempt to time your dosing to attenuate sleep
disturbance.
Boosts phosphocreatine ranges to provide ATP for robust power and better efficiency.
In medical analysis, when ladies take megadoses of Anadrol for very long periods of time, masculinization does not happen. This cycle is commonly utilized by customers in search of maximum weight acquire and dimension. These
are two of essentially the most efficacious bulking steroids combined in one cycle.
This outcomes from providing the physique with considerably greater quantities
of male androgen hormones like testosterone and DHT than would
in any other case be produced. These long-term side effects are
more likely to come back about from any other more powerful steroids you might be stacking Anavar
with quite than from Anavar itself. Anavar, unlike the
other oral prime labs steroids – https://entrenasalud.es
-, truly places larger stress on the kidneys than on the liver.
While you can count on a rise in liver enzymes whereas using Anavar, for most
people, this will be quite mild and should return to regular once you
stop using the steroid. The anabolic and androgenic
rankings of all steroids are compared in opposition to the usual score of testosterone, which has a good 100 for both.
In comparability, Anavar comes with a far larger
anabolic ranking however a a lot decrease androgenic ranking of simply 24 – which means its androgenic exercise is significantly milder than testosterone.
Trenbolone is one of the best recomp steroid but in addition the harshest AAS we will use.
It is imperative with steroids to not take prolonged cycles and to give the liver ample relaxation to regenerate post-cycle.
Bodybuilders could lose some measurement post-cycle from this stack,
which could be attributed to expelled intracellular water retention. In our expertise, the one steroid that is equal to Anadrol, in terms
of anabolism and rising weight acquire, is Dianabol.
Due To This Fact, novices don’t sometimes cycle Winstrol, as it can trigger
excessive levels of hepatotoxicity and cardiotoxicity.
This stack was one of the distinguished steroid cycles from the Golden Period, believed
to have been utilized by Arnold Schwarzenegger and other basic bodybuilders from the
1970s. This steroid cycle is a more standard protocol among intermediate
steroid customers. Anavar is a standard selection among novices because of its simultaneous discount of fat mass and improve of lean muscle.
Furthermore, probably the most advantageous steroid cycle for a male
may be distinct from that of a feminine, as ladies are inclined
to avoid compounds that induce virilization.
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steroid cycle examples (Embroidera.com)
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Steroid Experience – https://Terzas.Es/Temas/Tema002.Php,
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