Nuestro hombro anónimo empezó su vida deportiva muy pronto…. Era un hombro sano y feliz al que le gustaba practicar diferentes deportes, gracias a lo cual se fue haciendo un hombro fuerte, coordinado y hasta guapo. Con 9-10 años empezó a especializarse en un deporte con lanzamientos, bien podía ser balonmano, tenis, voleibol, lanzamiento de jabalina,… Hasta ahí todo normal.
Conforme fue ganando fuerza y sus lanzamientos cada vez eran más potentes, comenzaron a producirse adaptaciones que se traduce, entre otras, en una progresiva pérdida de rotación interna glenohumeral.
- Mayor grado de retroversión humeral: en respuesta a un estrés torsional repetitivo14,36,40,42,45,50, lo que permite una mayor rotación externa. Se trata de una adaptación ósea que se produce principalmente durante la adolescencia.
2. Mayor Stiffness de la musculatura posterior del hombro:6,8,19,23,28,35,39,46,60,62,69 Siendo una de las adaptaciones más comunes en este tipo de deportistas debido a la carga excéntrica de la musculatura rotadora externa frenando los lanzamientos, lo que produce daños en las sarcómeras43,44 (“Sarcomere popping”) provocando la liberación de calcio que conlleva contracción fibrilar con picos entre las 4 y 18 horas posteriores a una sesión de lanzamientos30, lo cual puede provocar a largo plazo plazo acortamiento muscular. Éste suele ser el principal mecanismo que provoca el DRIG entre 16-30 años30. De un reciente estudio con jugadores de beisbol2 se deduce que las adaptaciones agudas se deben principalmente a la Stiffness del manguito rotador posterior.
3. Retracción capsular posterior:10,58 Se ha demostrado mediante imagen por ultrasonidos, que los hombros lanzadores tienen una cápsula glenohumeral posterior más gruesa55,56; y mediante Elastografía, que la cápsula se vuelve más rígida (mayor “stiffnes”)53. Se ha relacionado a procesos de cicatrización en la cápsula posterior tras sucesivos desgarros producidos en los lanzamientos10,21,23,58,61,68, aunque hay algunos estudios que demuestran que en algunos casos ocurre lo contrario, que hay una mayor laxitud posterior de la cápsula5,7. Éste suele ser el principal mecanismo que provoca el DRIG entre 25-40 años30. Por comparación con el tipo de jugadores seleccionado en diferentes estudios hipotetizan que los jugadores profesionales y con mayor tiempo de exposición suelen presentar más adaptaciones capsulares2.
4. Neuromodulación a nivel central: Tras un análisis de regresión se deduce que sólo el 25% de la variabilidad en el ROM de rotación se predice por la Stiffness del manguito rotador y la retrotorsión humeral2. Aunque no ha sido todavía objeto de estudio, se ha hipotetizado que entre otros factores que limitan este ROM pueda encontrarse la neuromodulación a nivel central.
DRIG. Déficit de Rotación Interna Glenohumeral. Definida por Burkhart como una pérdida de rotación interna igual o mayor a 20° que el hombro contralateral. Aunque actualmente no hay un consenso total en cuanto a esta diferencia, ya que hay autores que la sitúan en 18°68, y otros en 25°51. 18º menos de rotación interna aumenta 1,9 veces el riesgo de lesión de hombro68. El DRIG en el brazo dominante del deportista que realiza lanzamientos está ampliamente demostrada3,5,7,9,10,11,16,26,38,40,41,45,49,67. En deportistas “overhead” asintomáticos el DRIG es de 10-15º de media15,27,38,57, mientras que los sintomáticos tienen una media de 19-25º38,58,59.
Los deportistas que realizan lanzamientos-golpeos por encima de la cabeza, Los “overhead”, a menudo tienen una excesiva movilidad14,47,54 en rotación externa, lo que contribuye a aumentar la velocidad de lanzamiento10,24,34,65.
De forma aguda, durante las 24 horas siguientes a un partido de beisbol, un pitcher ha perdido 9,5º de RI47. Se ha demostrado que el DRIG aumenta en el transcurso de una temporada deportiva18,47,52 y aumenta con el número de años de participación deportiva con lanzamientos29,48, lo que demuestra que el proceso de pérdida de rotación interna glenohumeral no acaba mientras la vida deportiva que conlleva lanzamientos continúa.
Si quieres saber porqué el DRIG puede llevarnos a la muerte del hombro anónimo lanzador, te recomendamos que leas la siguiente entrada: La muerte del hombro anónimo lanzador.
Y si quieres que la historia no acabe así te proponemos dos lecturas:
Y, evidentemente, no sólo que las leas, también que las apliques.
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