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16/11/2016 0 Comments

EL HOMBRO NADADOR DOLORIDO

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«Hola soy un hombro nadador, y me conocerán de una entrada anterior que precisamente se llamaba <El Hombro Nadador>. Tengo que reconocer que, a pesar de estar enamorado del agua y querer siempre estar entrenando y mejorando, siento dolor durante algunos periodos de cada temporada. Y veo que entre los otros hombros compañeros míos de profesión, suelen haber lesiones que aparecen con bastante frecuencia». 

Existen una serie de lesiones que son muy frecuentes en la natación y que la ciencia demás lo ha corroborado.

 

Lesiones de hombro Prevalentes en natación:

Los nadadores que padecen dolores de hombro tras los entrenamientos e incluso durante los mismos, se les dice que tienen «hombro del nadador», Un síndrome (el síndrome subacromial) que fue descrito por primera vez en 197432.

Síndrome subacromial1,5,43,44,45,54,60,74,75. Suelen presentar un arco doloroso entre 60-120º de abducción1,5,45. Dentro de este síndrome la lesión más común es la tendinopatía del supraespinoso3,20,49,54. En la técnica de crol, cuando la mano entra en el agua, se produce una fuerza de resistencia del agua sobre la mano que conlleva una hiperflexión de hombro, que puede ser un mecanismo importante de impingement74,75. Ver: La casita subacromial

Síndrome outlet torácico51 (compresión que sufre el plexo braquial, junto con las estructuras vasculares que le acompañan, durante su recorrido a través del cuello hasta su salida del tórax).

Impingement interno anterosuperior: Lo pueden sufrir los nadadores en el momento de la entrada de la mano en el agua64, ya que ocurre en la posición de aducción horizontal y rotación interna, y es un pinzamiento entre la glenoides y la cabeza humeral, pudiendo afectar los tendones del subescapular y supraespinoso, el intervalo rotador donde puede aparecer una sinovitis, los ligamentos glenohumeral superior y coracohumeral que pueden perder grosor o estar deshilachándose, el labrum anterosuperior (Lesión SLAP tipo IIa) y la cabeza humeral. Se trata de un mecanismo impingement que se confunde con el impingement subcoracoideo (Ver la entrada EL CUARTITO DEL SUBESCAPULAR: LA DISTANCIA CORACOHUMERAL).

Lesiones labrales11. Ver: Pum, crash, boom, SLAP. En el caso de los nadadores son lesiones por sobreuso asociado a microinestabilidad, no a una lesión por traumatismos.

 

Factores de riesgo de lesión: 

«Algunos investigadores me han estado estudiando a mi y a otros de mis compañeros que también tienen dolor, y han llegado a la conclusión de que hay una serie de factores que favorecen la aparición de nuestros dolores».

Rango de rotación externa glenohumeral superior a 100º o inferior a 93º67. Ver ITV Glenohumeral: Movilidad. Se ve con mayor frecuencia una reducción de la movilidad en rotación externa glenohumeral debido a un acortamiento de la musculatura propulsora que es mayoritariamente rotadora interna (pectoral mayor, dorsal ancho, subescapular)

 

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Historia previa de dolor de hombro60,67.

Nivel competitivo de élite son mucho más susceptibles de sufrir dolor de hombro34,54,76

Acortamiento de la musculatura pectoral23,60. Ver: Imputado el Pectoral Menor Corto

Reducida fuerza de rotación interna60. Ver: ITV Glenohumeral: Fuerza

Respiración unilateral: mayor predisposición de bursitis subacromial en el hombro contrario al del lado de la respiración15,60. Diversos autores defienden que la respiración bilateral permite mejor biomecánica24,37. De ahí que es importante enseñar una respiración bilateral desde las primeras fases de aprendizaje. 

Mala técnica:18,1930,31,32. Varios autores consideran que el factor más importante de entrenamiento y que mejor predice la aparición de lesiones en natación es la técnica14,16.

 

Hay otros factores que se han relacionado también con las lesiones de hombro, pero que presentan menor nivel de certeza científica.

DRIG (Déficit de rotación interna glenohumeral): Algunos estudios han demostrado que es un factor de riesgo60,67, aunque hay otros estudios donde no se encontró esta asociación8,23,48. Ver: Historia anónima de un hombro lanzador: DRIG.

Laxitud e inestabilidad: Cinco estudios encontraron una asociación entre este factor y el dolor de hombro3,8,39,60; y tres estudios no encontraron esta relación10,52,67.

Entrenamiento (Volumen, intensidad): Hay varios estudios que han encontrado asociaciones con el dolor de hombro34,47,54,60; mientras que otros no12,26,27,56,67. El exceso de entrenamiento puede llevar a fatiga y ésta a alteraciones en la técnica, lo que es un factor de riesgo de lesión40.

Estabilidad del Core: Un estudio encontró asociación con el hombro doloroso60 y otro no23.

 

De acuerdo, el hombro nadador puede estar sufriendo, pero eso no quiere decir que lo tenga que hacer forzosamente, y mucho menos que se merezca sufrir estas lesiones. Evidentemente un buen entrenamiento es el camino a la prevención y recuperación de estas lesiones y dolores de hombro. Muy atentos a las próximas entradas

 

 

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