Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Cunha, Natália de Souza; Sinhorim, Larissa; Schleip, Robert; Zomkowski, Kamilla; Santos, Gilmar Moraes; Sperandio, Fabiana Flores

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Fisioterapia em Movimento

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Original Article • Fisioter. mov. 35 (spe) • 2022 • https://doi.org/10.1590/fm.2022.35609 copiar

Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução:

O câncer de mama é o tipo de câncer mais comum entre as mulheres. Os tratamentos podem levar a complicações, modificando os padrões de movimento dos membros superiores e gerando dor e perda de funcionalidade. A cinesioterapia e a reorganização miofascial (RM) têm demonstrado efeitos positivos na redução da dor crônica e na melhora da função dos membros superiores. A hipótese do presente estudo é que essas técnicas podem maximizar os resultados e reduzir o tempo de tratamento na prática clínica.

Objetivo:

Desenvolver um protocolo para verificar se a RM associada à cinesioterapia é mais eficaz do que a cinesioterapia isolada no tratamento da dor crônica e disfunção do membro superior em sobreviventes de câncer de mama.

Métodos:

As participantes serão divididas em dois grupos: grupo intervenção (reorganização miofascial + cinesioterapia) e grupo sham (massagem tradicional + cinesioterapia). Serão realizadas seis sessões de tratamento (uma vez por semana) e três avaliações. Os instrumentos de avaliação da dor e da funcionalidade serão a Escala Visual Analógica, o Diagrama de Dor Corporal, o Questionário de Deficiências do Braço, Ombro e Mão e a goniometria. A análise estatística será realizada com base na análise de intenção de tratar. Para analisar a diferença de médias entre os grupos, serão utilizados o teste T-Student ou U Mann-Whitney. ANOVA de medidas repetidas será utilizada para verificar os efeitos dos tratamentos. O nível de significância para todos os testes será de 5%.

Conclusão:

Espera-se que a RM associada à cinesioterapia melhore a dor crônica e a funcionalidade dos membros superiores de sobreviventes de câncer de mama.

Palavras-chave:
Câncer de mama; Dor crônica; Funciona-lidade; Terapia manual; Modalidades de fisioterapia

Techniques sequence	Techniques description
A. Sternal region	Participant: supine position with knees bent. Therapist: standing in front of the participant's head. Technique: the therapist fixes one hand in the region of the nuchal ligament and the other hand over the sternum, making a smooth and progressive caudal pressure towards the stretcher (1 minute).
B. Anterior ribcage region	Participant: supine position with knees bent. Therapist: standing in front of the participant's head. Technique: the therapist performs pressure and sliding from the xiphoid process, passing through the sternum, the infra clavicular region and ending at the acromion (6 times).
C. Diaphragm reorganization	Participant: supine position with knees bent. Therapist: standing beside the stretcher, in front of the participant's pelvis. Technique: the therapist performs pressure and sliding from the xiphoid process to the lower borders of the last ribs (6 times).
D. Pectoralis major	Participant: supine position with knees bent. Therapist: standing beside the stretcher, in front of the participant's chest. Technique: the therapist fixes one hand on the humerus and applies pressure towards the sternum with the other hand (1 minute).
E. Scapular region 1	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's abdomen. Technique: therapist performs pressure and sliding on the medial and upper border of the scapula (6 times).
F. Scapular region 2	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's abdomen. Technique: therapist departs the scapula from the ribcage and performs scapular mobilization in eight (1 minute).
G. Scapular region 3	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's abdomen. Technique: the therapist places the thumb in the region of teres minor muscle and applies sustained pressure (1 minute).
H. 45° Lateral trunk	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's posterior thorax. Technique: therapist with hands overlapped at 45 ° with the lateral region of the participant's thorax, performs pressure between the 6th and 8th ribs towards the stretcher and shoulder of the participant (1 minute).
I. Lateral trunk region	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's posterior thorax. Technique: therapist positions one hand on the upper thorax and the other on the lower thorax, the upper hand remains fixed and the lower one moves in a caudal direction (1 minute).
J. Thorax reorganization	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's posterior thorax. Technique: therapist places one hand on the anterior region of the last ribs and the other hand in the region of the inferior angle of the scapula, applying twisting pressure in a cranial direction (1 minute).

Exercises sequence	Exercises description
1. Stretches	Seating, participants will stretch pectoral, levator scapulae, trapezius and latissimus dorsi. Each position will be held for 1 minute and 30 seconds.
2. Codman's pendulum exercise	Participants will stand with torso flexed over hips at 90º and one arm hanging in a 60º to 90º flexion or abduction position in the scapular plane. Participants will perform circling movements for 1 minute and 30 seconds. Dumbbells up to 1 kg will be used.
3. Scapular mobilization	Participants will stand, face the mirror and perform scapular adduction, abduction, elevation and depression movements. 1 set of 10 repetitions for each movement.
4. Shoulder flexion and abduction	Participants will stand, close to the wall, performs flexion and abduction movements in the scapular plane, sliding her hands along the wall. 1 set of 10 repetitions for each movement.
5. Shoulder elevation with dumbbells	Participants will stand, performs scapular elevation and depression with arms parallel to the body holding dumbbells. 2 sets of 10 repetitions. Dumbbells up to 1 kg will be used.
6. Seated chest press with dumbbells	Participants will be seated with upper limbs in 90º of shoulder flexion and full elbow extension, with pronated forearms, will bring the dumbbells towards the chest performing elbow flexion. 2 sets of 10 repetitions. Dumbbells up to 1 kg will be used.
7. Diagonal patterns exercises	Diagonal D1 flexion: participants will sit, start with shoulder extended, abducted, and internally rotated and end with shoulder flexed, adducted, and externally rotated. Diagonal D2 flexion: participants will sit, start the exercise with shoulder extended, adducted, and internally rotated and end with shoulder flexed, abducted, and externally rotated. 2 sets of 10 repetitions for each diagonal. Dumbbells up to 1 kg will be used.
8. Full can exercise	Participants will stand up, perform shoulder abduction with the elbows extended in the scapular plane, the humerus in external rotation and the thumbs pointing upwards, holding dumbbells. 2 sets of 10 repetitions. Dumbbells up to 1 kg will be used.
9. Scapular stabilization exercise	Participants will stand with shoulders flexed at 90º and hands on the wall, and will perform scapular abduction and adduction keeping hand contact with the wall and elbows extended. 2 sets of 10 repetitions.

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