LOGO FIDIAS NARANJA Y NEGRO 2021
08/03/2017 0 Comments

¿Qué hago con mi séptima lesión isquiotibial?

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Cuando tienes un bíceps femoral que es un pupas y te dedicas a correr, es habitual lesionarse 7 veces a lo largo de una vida deportiva, y que este deportista tenga una sensación de impotencia absoluta también. De esta situación a la depresión deportiva solo hay un pasito.

Evidentemente una opción es esperar. El tiempo lo cura casi todo. Pero quizás no sea la mejor para evitar recidivas, y además, ¿Quién está dispuesto a renunciar a una posible recuperación más rápida?  Estas lesiones las sufren los deportistas, y como tales, no hay nada que les deprima más que perderse competiciones y semanas de preparación.

Si quiero acelerar la recuperación debo poner a todos los profesionales de la salud a mi disposición. Imprescindible al médico que valore la lesión, estimando el grado de distensión o rotura fibrilar, estableciendo los tiempos y fases de la recuperación, y coordinándola. Imprescindible el físioterapeuta en la aceleración de los procesos de reparación de los tejidos y la prescripción de ejercicios de rehabilitación. Por último, imprescindible el especialista en ciencias de la actividad física y el deporte, que siguiendo las pautas del médico y aprovechando el trabajo del fisioterapeuta, debe asumir la última fase de recuperación donde el deportista hace su puesta a punto para la competición, y aportando un plan de prevención dentro de su planificación de entrenamiento.

A corto plazo el objetivo diana de la recuperación es mejorar la relación longitud muscular-tensión. Y la progresión lógica es:

  • Ejercicios con pico de fuerza cada vez con mayor longitud muscular79.
  • De ejercicios concéntricos a ejercicios excéntricos.
  • De ejercicios de cadena cinética cerrada a ejercicios de cadena cinética abierta
  • Ejercicios cada vez más específicos
  • Aumento de la carga y de la velocidad de ejecución. (F=ma).

El parámetro clave para diferenciar las fases es la longitud muscular. En base a eso diferenciarlos tres fases.

1°Fase: Acortamiento.

En esta fase están contraindicados los estiramientos.

En la primera fase se recomendará un trabajo de fuerza concéntrica con rangos de amplitud articular cortos, debido a que se han sobreestirado las fibras y está contraindicado trabajar en rangos amplios y con carga excéntrica. Se impide el estiramiento con el fin de evitar que se perjudique la formación de tejido cicatricial. En estos casos es muy probable que el músculo pierda sarcómeros en serie y muestre una atrofia considerable. De esta manera, la longitud óptima se producirá en posiciones más cortas del músculo. En los ejercicios de la imagen se recomendaría realizar exclusivamente los últimos grados del recorrido.

 

2°Fase: Rangos medios.

 

Probablemente el ejercicio nórdico sea el más estudiado desde que Brackett et al12 lo utilizaran por primera vez en un estudio.

Este ejercicio reduce la aparición de esta lesión por primera vez2,13,64,85, y las recidivas64.
Y mejora la relación longitud-tensión desde una única sesión de trabajo12;

Clark et al.17 en 4 semanas de trabajo, con 2-3 series de 6-8 repeticiones, 2-3 veces por semana, mostró una mejora de la longitud óptima de 6,5º.

Schache70, en un estudio entre casi 1000 futbolistas daneses mostró 15 lesiones de isquiotibiales en el grupo que realizó un entrenamiento preventivo (Nordic curl excéntrico) por 52 lesiones del grupo control. Una reducción del 71%. El entrenamiento consistió en 27 sesiones en 10 meses a razón de 2-3 series de 5-12 repeticiones, 1-3 sesiones por semana.

CRITICAS:

  • Poca funcionalidad del ejercicio, en cuanto que se realiza con longitudes musculares por debajo de la longitud de reposo, ya que la rodilla está flexionada y la cadera en flexión neutra. Por lo tanto, y a pesar de su demostrada eficacia en reducir las lesiones de isquiotibiales, no es un ejercicio muy específico para prevenir las lesiones cuando la longitud muscular sobrepasa la longitud de reposo.
  • Movimiento monoarticular (sólo en la rodilla) cuando la mecánica de movimiento del músculo es biarticular (cadera y rodilla).
  • La acción simultánea de las piernas que puede provocar que los isquiotibiales de una pierna se activen más que los de la otra. Tanto  Brockett et al.12,  como Clark et al.17  mostraron diferencias en la longitud óptima entre ambas piernas. Clark et al17 mostró una diferencia aún mayor tras un entrenamiento de 4 semanas con el ejercicio nórdico.
  • Activa en mayor grado los isquiotibiales internos que el bíceps femoral10.

 

En el estudio de Orishimo & McHugh63 este ejercicio fue el que obtuvo mayor activación en la fase excéntrica del bíceps femoral.

Entrenamiento de 10 semanas con futbolistas utilizando el yo-yo hamstring curl redujeron las lesiones de isquiotibiales en un 67% respecto al grupo de control6.

El entrenamiento excéntrico de los isquiotibiales es el único factor estudiado que ha demostrado reducir el índice de lesión muscular aproximadamente en un 60-70%3,6,46,54,64,85.

3°Fase: Elongación muscular.

 

Con el ejercicio de isquiotibiales con cinturón ruso se obtuvieron mejoras parecidas que con el Nórdico67.

El peso muerto demostró mayor actividad excéntrica del bíceps femoral que el «Good Morning», el «Glute-Ham Raise» y el «Prone leg curl»56.

 Y nuestro preferido

No hemos encontrado estudios que lo analicen electromiográficamente, al menos con una versa-pulley. Pero analizando sus características nos parece el más adecuado para prevenir estas lesiones, y como última fase de la recuperación.

Es evidente que la progresión en la especificidad es absolutamente indisoensable….

En cuanto a la ganancia de movilidad, ya hemos dicho que está contraindicada en las primeras fases, y proponemos estiramientos en tensión activa.

 Entonces, ¿Qué hacemos? ¿Esperamos, o nos ponemos manos a la obra?

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