KINETIC CONTROL: Estabilidade Dinâmica e Equilíbrio Muscular
Autor: Pablo B. Marinho, FT

Criado há mais de 10 anos pelo fisioterapeuta e pesquisador australiano Mark Comerford (pioneiro no conceito de estabilização músculo-esquelética) e pela fisioterapeuta inglesa Sarah Mottram, o Conceito evoluiu muito ao longo dos anos e hoje a estabilização é o tema dos principais congressos mundiais em reabilitação músculo-esquelética.

Pesquisas recentes demonstram a existência de alteração no padrão de movimento em indivíduos que apresentam dor. Os estudos mostram que esses indivíduos adotam padrões de movimento que deveriam estar sendo usados apenas em tarefas que exigem força (com carga) para realizar tarefas funcionais (“sem peso”) como caminhar, ou levar a mão à cabeça.

Mark Comerford sugeriu uma nova classificação muscular, vendo que as classificações anteriores eram muito incompletas. Ele dividiu os grupos musculares em estabilizadores e mobilizadores, sendo que os estabilizadores apresentam duas subdivisões: estabilizadores locais e globais.

Os estabilizadores locais são músculos pequenos e profundos incapazes de realizar movimento, portanto, sua função principal é o controle da translação (deslizamentos) das articulações através de contrações isométricas. Os estabilizadores globais são um pouco mais superficiais e têm como função principal a realização de movimentos funcionais e o controle excêntrico dos movimentos. Já os mobilizadores são representados pelos grandes grupos musculares que se apresentam superficialmente aos demais. Têm a função de gerar, através de contrações concêntricas, velocidade e força. Possuem função estabilizadora, apenas, quando há carga excessiva.



O Kinetic Control é um sistema de avaliação e tratamento que prioriza a estabilidade dinâmica e o equilíbrio muscular. Na avaliação, as informações colhidas são clinicamente interpretadas e a partir daí é realizada a análise do movimento funcional, verificando disfunções, para serem desenvolvidos planos de tratamento objetivando a restauração da estabilidade funcional, do alinhamento articular e do equilíbrio muscular. O tratamento é realizado de forma individual e específica a cada problema de cada indivíduo.
O Conceito trabalha com quatro princípios, na restauração da estabilidade
funcional:
- Controle da Direção;
- Controle da Translação;
- Controle da Amplitude de Movimento;
- Controle da Extensibilidade.

CONTROLE DA DIREÇÃO
Este princípio está muito relacionado com a consciência corporal, ou seja, é a capacidade do indivíduo em dissociar o movimento entre os segmentos corporais. O indivíduo deverá realizar o movimento em um segmento enquanto mantêm o adjacente em posição neutra. Exemplo: realizar uma flexão de coxa sem deixar a coluna lombar flexionar junto.

CONTROLE DA TRANSLAÇÃO
Será trabalhada nesse princípio, a capacidade do indivíduo em controlar a translação (deslizamento) articular através de uma boa contração sustentada, em baixa carga (“sem peso”), dos estabilizadores locais. Músculos profundos que apresentam sua função inibida quando há um quadro de dor.

CONTROLE DA AMPLITUDE DE MOVIMENTO
Trabalharemos o controle do movimento que está gerando os sintomas (dor, formigamentos, queimação...), através da ativação dos estabilizadores globais, que devem ser capazes de contrair, realizando seu encurtamento máximo, manter a posição e realizar o controle excêntrico no retorno à posição inicial.

CONTROLE DA EXTENSIBILIDADE
Neste princípio, o indivíduo deve ser capaz de atingir, passivamente, a amplitude completa das articulações. Deve-se garantir que os mobilizadores ou o tecido conectivo não estão gerando encurtamentos ou limitações de movimento, o que pode gerar uma falsa impressão de mau funcionamento dos estabilizadores globais.

O Kinetic Control nos permite achar segmentos corporais que estejam fracos e/ou instáveis, que, na verdade, são futuros candidatos a lesões. Avaliando-se os princípios, acima citados, temos condições de chegar a este diagnóstico precoce, mesmo não havendo dor local. Segmentos instáveis podem provocar dor e promovem o desgaste excessivo e precoce das articulações, cartilagens e discos vertebrais, além de lesões de ligamentos e tendões. Na maioria das vezes o quadro de dor melhora em alguns dias ou semanas, mas estudos mostram que a disfunção se mantém presente, provocando a reincidência (retorno) insistente dos sintomas.

Um diagnóstico funcional bem feito e uma abordagem fisioterapêutica específica e individual são imprescindíveis para se obter sucesso num processo de reabilitação. A maioria das dores músculo-esqueléticas ocorre durante a realização de um ou mais movimentos, portanto, a reabilitação deve seguir o mesmo princípio para que sejam evitadas as reincidências.


SISTEMA DE CONTROLE DO MOVIMENTO FUNCIONAL PARA EXCELÊNCIA CLÍNICA

Diagnóstico, Classificação e Treinamento do Controle Motor na Disfunção de Movimento

Pesquisas recentes mostram claramente que pessoas com dor, apresentam padrões de movimento alterados, e assim, adotam padrões que, normalmente, deveriam estar sendo usadas em tarefas de alta carga, para realizar movimentos funcionais. O Kinetic Control pode ajudar o terapeuta a compreender os mecanismos, identificar e tratar esses padrões alterados de movimento.

Nossos cursos buscam desenvolver o seu conhecimento na avaliação, diagnóstico, classificação e abordagem das disfunções de movimento. Nosso processo oferece ao terapeuta ferramentas para:

- Identificar a real prioridade clínica;
- Avaliar, diagnosticar e classificar o movimento em relação à dor e a disfunção de uma perspectiva biomecânica e motora;
- Ter disponível em mãos uma grande quantidade de estratégias e abordagens para um bom treinamento motor, garantindo qualidade no movimento funcional e diminuição efetiva das reincidivas;
- Use um raciocínio clínico sustentado como prioridade na tomada de decisão durante a prática clínica habitual;
- Use habilidades refinadas de observação e palpação, e aprenda a usar a unidade pressórica como biofeedback do recrutamento e controle muscular.
- Use técnicas de taping para dar suporte ao movimento instável ou facilitar o aprendizado motor.
- Desenvolver uma análise sustentada que será essencial no diagnóstico de:

1. Disfunção
- localização e direção do movimento instável
- translação descontrolada
- restrições miofasciais e articulares
- respostas espásticas

2. Diagnóstico de dor em tecidos sensíveis

3. Diagnóstico dos mecanismos de dor
- sensibilização mecânica inflamatória
- sensibilização neurogênica do SNC
- respostas de comportamento

- Use uma ferramenta de análise clínica para identificar deficiências e reavaliar melhoras no controle motor;
- Re-integre exercícios não-funcionais em movimentos funcionais;
Nosso processo inclui:
- Diagnóstico, classificação e treinamento do controle motor nas disfunções de movimento na coluna lombar, articulação sacroilíaca, quadril, coluna cervical e cintura escapular.
- Uma revisão da biomecânica do movimento funcional normal.
- Uma revisão biomecânica da disfunção que produz patologia e estresse nos tecidos.
- Relacionar os testes funcionais aos sintomas.
- Um raciocínio clínico baseado para identificar prioridades na reabilitação, quando iniciar o treinamento e como ser bem específico e eficiente na prescrição dos exercícios.
- Uma visão de como escolher a velocidade e o modo de progredir, e como dizer que o objetivo de controle independente foi atingido.
- Controle direcional para um diagnóstico evidenciado.
- Desenvolvimento dos princípios de reabilitação e aplicação das
estratégias de treinamento dos sistemas musculares local e global:
- Controle da direção
- Controle da translação
- Controle do desequilíbrio – controle global através da amplitude e extensibilidade do sistema global

- Como utilizar os recentes achados científicos na prática clínica.
- Entender sobre limiar de recrutamento – aplicar os princípios da neurofisiologia no planejamento do treinamento motor nas disfunções de movimento.
- Uma revisão da função muscular evidenciada nos últimos estudos, e considerações a respeito da função muscular nos grupos monoarticulares e poli-articulares.
- O Kinetic Control tem promovido cursos de estabilização pelo mundo todo há mais de uma década e 2007 será o terceiro ano em que o curso estará sendo ministrado no Brasil. Os cursos oferecidos pelo Kinetic Control são reconhecidos internacionalmente e essa é a primeira vez em que estarão sendo ministrados em português pela Instrutora Credenciada Elisângela Bof. Não perca a oportunidade de participar da terceira turma do Brasil.

ACESSE AGORA: www.kineticcontrol.com


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