EPICONDILITE: L’EFFICACIA DEL TRATTAMENTO CONSERVATIVO PER IL DOLORE LATERALE DI GOMITO
Autore: Fisioterapista Tommaso Consoli
Fisioterapia e Osteopatia a Brescia
Soffri di dolore alla regione laterale del gomito? Senti parlare di “gomito del tennista” ma non pratichi tennis? Hai notato una debolezza nella presa per dolore al gomito?
In questo articolo ti spiegheremo cos’è l’epicondilite e come possiamo aiutarti per risolvere il problema
Tempo di lettura: 4 minuti
FACCIAMO CHIAREZZA
L’epicondilite laterale, conosciuta come “gomito del tennista”, è un disturbo muscoloscheletrico che rappresenta la causa più comune di dolore alla porzione laterale del gomito.
Nonostante il nome possa trarre in inganno, non si tratta esclusivamente di una condizione sport-correlata, infatti, solo una minima percentuale dei soggetti con epicondilalgia pratica tennis.
Generalmente si può affermare che tale condizione sia causata da sovraccarico meccanico e microtraumatismi ripetuti nel tempo in soggetti che praticano attività lavorative o sportive che prevedono movimenti ripetitivi in flesso-estensione di polso, spesso associati a salde prese, estensione di polso forzata oppure traumi diretti all’epicondilo.
I PROTAGONISTI DELL’EPICONDILITE
Prima di spiegare come possiamo esserti utili, è necessario individuare le strutture anatomiche coinvolte nel disturbo.
Semplificando al massimo, poniamo la nostra attenzione sulla muscolatura estensoria di polso e mano (in rosso) e sulla componente ossea a cui si agganciano, l’epicondilo laterale dell’omero.
La regione tendinea che si frappone fra il tessuto contrattile del muscolo e il tessuto inorganico/non
contrattile dell’osso rappresenta una zona critica del tendine in quanto ha il compito di trasmettere le forze dal ventre muscolare al segmento osseo ma allo stesso tempo dissipare le forze in eccesso. Un sovraccarico a livello di questa struttura determina dei cambiamenti biologici e strutturali della porzione di tendine coinvolta con conseguente irrigidimento e dolore.
Il principale responsabile del dolore laterale di gomito è il tendine del muscolo estensore radiale breve del carpo.
PERCHÉ RIVOLGERSI AD UN FISIOTERAPISTA?
Perché la letteratura scientifica in nostro possesso indica che la gestione conservativa per mano di clinici esperti è l’intervento di maggior efficacia nella risoluzione del problema, il trattamento chirurgico va tenuto in considerazione in rari casi in cui il paziente non risponde al trattamento fisioterapico.
Rivolgersi ad una figura specializzata consente di inquadrare correttamente il problema, escludendo altre cause che possono provocare dolore alla regione laterale di gomito.
Inoltre, come in tutte le sofferenze tendinee, si distinguono tre fasi della patologia (di seguito velocemente sintetizzate) a cui corrispondono diverse possibilità di intervento terapeutico.
- Fase reattiva: acuto sovraccarico con conseguente ispessimento tendineo e aumento della rigidità
- Fase di disriparazione: tentativo fallimentare di riparazione, tipica dei tendini cronicamente sovraccaricati
- Fase di degenerazione: deterioramento progressivo delle componenti tendinee, con microlacerazioni e possibilità di rottura
Attraverso un’accurata valutazione, i nostri fisioterapisti sapranno guidarti tra le varie fasi, verso l’intervento più opportuno per la risoluzione del dolore.
Contattaci per un consulto
COME POSSIAMO AIUTARTI?
Con i nostri professionisti avrai la possibilità di confrontarti per apportare delle modifiche alle attività lavorative o sportive che possono essere responsabili del tuo disturbo.
Infatti, modificare parzialmente una gestualità come la presa di oggetti o il sollevamento di carichi può favorire una riduzione delle stimolazioni a carico dei tendini responsabili del dolore.
Questo intervento ha un’importanza fondamentale vista la significativa disabilità funzionale sul lavoro, nello sport e nelle attività ricreative, che potrebbero determinare una riduzione della partecipazione.
L’esercizio terapeutico è l’intervento più efficace nella regressione del dolore; con i nostri terapisti troverai il tuo punto di partenza e, gradualmente, costruiremo progressioni di carico affinché sia ben tollerato dai tuoi tessuti.
L’attività aerobica e l’allenamento dei distretti non direttamente coinvolti dal dolore hanno un’azione metabolica con effetto analgesico sistemico che può essere utile nelle fasi iniziali di dolore e, inoltre, consente di mantenere il corpo allenato alle sollecitazioni di carico.
In particolare, si segnala l’importanza di allenare la cuffia dei rotatori (struttura che puoi approfondire nell’articolo in materia presente sul sito) la cui debolezza sembra essere un fattore determinante per lo sviluppo della patologia.
Combinati agli esercizi, l’utilizzo di tecniche di terapia manuale come particolari tipi di mobilizzazioni possono essere utili per ridurre la reattività dei tessuti.
L’utilizzo del tutore per l’avambraccio, del kinesio taping piuttosto che delle terapie fisiche (classica prescrizione di onde d’urto) sono strategie di intervento secondarie che possono essere prese in considerazione nella gestione dell’epicondilite.
Tra gli interventi ad appannaggio medico, il più efficace, soprattutto nella fase reattiva, è la farmacoterapia; l’intervento chirurgico è sconsigliato, trova applicazione in caso di completo fallimento dell’intervento conservativo.
Autore: Fisioterapista Tommaso Consoli
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