Relação da oclusão dentária na presença de curvaturas não fisiológicas da coluna vertebral / Relationship between dental occlusion and non-physiological curvature of the vertebral column

O objetivo desse trabalho foi verificar a relação entre a oclusão dentária e as curvaturas não fisiológicas da coluna vertebral. A amostra foi composta por 88 indivíduos com diagnóstico médico e radiográfico confirmado de desvio postural, atendidos em Ambulatório Médico-Odontológico noEstado de João Pessoa-PB. Para a coleta de dados realizou-se um exame clínico da oclusão dentária em relação vertical de normalidade, mordida em topo, aberta e profunda. Posteriormente a relação transversal de oclusão foi qualificada em normalidade, desvio de linha média, apinhamento inferior e/ou superior e mordida cruzada posterior uni ou bilateral. A relação ântero-posterior foi determinada conforme classificação de Angle em: normalidade, classe I, II e III. Os dados obtidos foram submetidos ao tratamento estatístico pelo teste Exato de Fisher com nível de significância de 5%. Os resultados demonstraram uma diferença estatisticamente significante entre as curvaturas não fisiológicas da coluna vertebral e as relações vertical e ântero-posterior de oclusão, assim como diversos tipos de mal oclusão dentária entre indivíduos com curvaturas não fisiológicas da coluna vertebral. Não foi observada relação estatisticamente significante entre gênero e idade nos indivíduos examinados. Conclui-se que há um desequilíbrio no sistema manducatório pode estar intimamente relacionado a presença de alterações posturais na coluna vertebral.

This study aims to verify the relation between dental occlusion and no physiological curvature of the spinal column. The sample consisted of 88 individuals with a clinical diagnosis and confirmed radiographic postural deviation, treated at Medical-Dental Clinic in the state of Joao Pessoa-Pb. For data collection it was carried out a clinical examination of the dental occlusion in vertical relationship of normality, bite the top, open and deep. Later the transversal occlusion was qualified inrelation normality, midline deviation, crowding and posterior crossbite. The vertical anterior-posterior occlusion relation was determined according to Angle classification: normal, class I, II and III. The obtained data were subjected to statistical analysis by Fisher exact test with a significance level of 5%. It was found that there was a difference statistically significant between the non-physiological curvatures of the spine and the vertical and ânterior-posterior occlusion relation as well as various types of dental malocclusion among individuals with no physiological curvature of the spine. No statistically significant relationship between gender and age it was observed. Data suggest there isan imbalance in the system can be closely related to the presence of postural changes in the spine.

Valoración del morfotipo raquídeo en el plano sagital en ciclistas de categoría máster 40 / Spinal posture of thoracic and lumbar spine in master 40 cyclists

El objetivo principal del estudio fue valorar la disposición sagital del raquis torácico y lumbar en bipedestación y sobre la bicicleta, en ciclistas de la categoría máster 40. Un total de 50 ciclistas máster 40 (media de edad: 44,02 +/- 2,51 años) fueron evaluados mediante el sistema Spinal Mouse en bipedestación y sobre la bicicleta en tres agarres del manillar: transversal, de manetas y bajo. En bipedestación, los valores angulares medios para el raquis torácico y lumbar fueron de 49,42 +/- 9,00 y -22,74 +/- 9,38, respectivamente. Un elevado porcentaje de los ciclistas (68 por ciento) presentaron una hipercifosis torácica, mientras que la mayoría tenían valores normales en la lordosis lumbar. Sobre la bicicleta, los ciclistas mostraron una reducción significativa de la cifosis torácica con respecto a la bipedestación, mientras que el raquis lumbar se disponía en una postura de inversión. En conclusión, la frecuente hipercifosis torácica en bipedestación de los ciclistas de la categoría máster 40 no está relacionada directamente con la postura adoptada sobre la bicicleta.

The aim of this study was to determine the sagittal spinal morphology of thoracic and lumbar spine in relaxed standing and sitting on the bycicle in master 40 cyclists. A total of 50 master 40 male cyclists (mean age: 44.02 +/- 2.51 years) were evaluated. The Spinal Mouse system was used to measure the sagittal thoracic and lumbar curve in standing and sitting on the bicycle at three different handlebar-hand positions (high, medium, and low). The values for thoracic and lumbar curvatures in standing were 49.42 +/- 9.00 and -22.74 +/- 9.38, respectively. A high frecuency of thoracic hyperkyphosis in standing was observed (68 percent). When sitting on the bicycle the thoracic curve showed lower angles in the three handlebar.hand positions that in standing. The lumbar curve adopted a kyphotic posture. The standing thoracic hyperkyphosis in master 40 cyclists may be related to other factors than the posture adopted on the bicycle.

Consideraciones neuromecánicas y neurofisiológicas en la rehabilitación espinal lumbar / Neurophysiologic and neuromechanics concepts in the management of chronic lumbar syndrome

El síndrome de dolor lumbar crónico está asociado a una serie de disfunciones, neuromecánicas, neurofisiológicas y trastornos emocionales, siendo de consenso mundial que el abordaje terapéutico debe basarse en el modelo biopsicosocial, donde el factor emocional es el más relevante. Desde el punto de vista neuromecánico, estudios biomecánicos de correlación y electrofisiológicos de elevada confiabilidad, señalan que la columna vertebral es inherentemente inestable y que su estabilidad depende tanto de la integridad del sistema sensorio motriz como de la indemnidad de los tres subsistemas de control espinal, siendo los mecanismos de respuesta aferentes (feedback) y eferentes (feedforward) indispensables para el control motor articular. Desde el punto de vista neuromuscular, toda activación muscular asociada a un movimiento de un segmento corporal se acompaña de un patrón motor y de movimiento específico para dicha acción, donde cada patrón de movimiento posee un patrón secuencial de activación muscular tipo, el cual puede variar en presencia de disfunción. Se postula que la cocontracción de la musculatura abdominal y paravertebral es fundamental para lograr la estabilidad espinal al aumentar la rigidez vertebral. Esta actividad muscular debe ser coordinada en intensidad, tiempo y frecuencia para desencadenar los mecanismos protectores de la estabilidad espinal. La disfunción del sistema muscular estabilizador local y global está asociada al síndrome de dolor lumbar crónico, donde la reeducación de la contracción muscular a través de respuestas motoras voluntarias, reflejas e involuntarias del sistema muscular estabilizador es fundamental para evitar recidivas y reagudizaciones. Es decir, el objetivo final y esencial en un proceso de rehabilitación espinal es convertir el control consciente del movimiento correcto a un nivel inconciente. El objetivo de esta revisión es entregar conceptos neurofisiológicos y neuromecánicos de avanzada según medicina basada...

The chronic lumbar pain syndrome is associated to a series of neuro-mechanic neurophysiologic dysfunctions and emotional disorders, being world-wide known that the therapeutic approach must be based in the bio-psychosocial model, where the emotional factor is the most relevant. From the neuro-mechanic point of view, bio-mechanic studies of correlation and highly reliable electro-physiologic studies indicating that the vertebral column is inherently instable and that its stability depends both of the sensor motor system integrity as well as of the three spinal control subsystems indemnity, being the feedback response and feed-forward mechanism essential for the articular motor control. From the neuromuscular point of view, al! muscular activation associated to a corporal segment movement is accompanied of a motor pattern and of specific movement for said action; where each movement pattern has a sequence of muscular type activation, which may vary when there is a dysfunction. It is assumed that the abdominal muscular and para-vertebral cocontraction is fundamental to achieve the spinal stability when increasing the vertebral rigidity. This muscular activity must be coordinated in intensity, time and frequency to generate the protective mechanism for the spinal stability. The muscular system dysfunction of the local and global muscular stabilizer is associated to chronic lumbar pain, where the reeducation of the muscular contraction by means of voluntary, reflex and involuntary motor responses of the muscular stabilizer system is fundamental to avoid relapsing and acute exacerbation. Likewise, the final and essential objective in a spine rehabilitation process is to convert the conscious control of the correct movement to an unconscious level. The objective of this review is to deliver advance neurophysiologic and neuro-mechanical concepts according to medicine based on evidence, fundamental for the development of essential therapeutical strategies in the...

Disfunción de los mecanismos de feedforward del transverso abdominal en presencia de dolor lumbar / Dysfunction of feedforward mechanisms of the transversus abdominis in the presence of low back pain

El transverso abdominal posee características neuro biomecánicas fundamentales para lograr la estabilidad de la columna vertebral. En sujetos asintomáticos de dolor lumbar, la evidencia ha reportado una actividad neuromuscular anticipatoria del transverso abdominal, donde la función principal de la activación anticipada de ciertos grupos musculares es brindar estabilidad a los segmentos articulares o vertebrales. Por otro lado, cambios a nivel del timing de activación del TrA han sido evidenciados en sujetos con dolor lumbar. Este retardo en el timing de activación reflejan estrategias disfuncionales del SNC para lograr la estabilidad vertebral. El retraso en el timing de activación del TrA en todos los sentidos del movimiento de las extremidades y del tronco, y en presencia de movimientos de los miembros a velocidades moderadas y rápidas en sujetos con dolor lumbar, se interpreta como una pérdida del mecanismo de FFW de la musculatura estabilizadora de tronco, lo cual se refleja clínicamente con un aumento en la carga espinal asociada a una reducción funcional de los mecanismos de protección espinal neuromusculares. A la luz de la evidencia, los kinesiólogos hoy en día constamos con información relevante avalada por estudios biomecánicos, de correlación, de electrofisiología neuromuscular y de imagenología diagnóstica para desarrollar estrategias terapéuticas que contribuyan al manejo de las disfunciones asociadas al SDLC.

The tranversus abdominis has neuro biomechanics characteristics fundamental to get the spine stability. In subjects without lumbar pain symptoms, the evidence has reported an anticipatory neuromuscular activity of the Tranversus Abdominis, where the main function of the anticipatory activation of certain muscle groups is to provide stability to the joint or vertebral segments. On the other hand, changes on the activation timing of the Transversus Abdominis have been observed in subjects with lumbar pain. This delay on the activation timing reflects dysfunctional strategies of the SNC to get vertebral stability. The delay on the activation timing of the Transversus Abdominis in all directions of motion of limbs and trunk, and on presence of moderate and high speed motions of the limbs on subjects with lumbar pain, is interpreted as a lost of the feed-forward mechanism of the trunk stabilizing muscles, which is clinically reflected as a rise of the spinal load associated to a functional decrease of the neuromuscular spinal protection mechanisms. With all this evidence, at present the physical therapists have relevant information supported by diagnostic imaging, neuromuscular electrophysiology, and biomechanical studies to develop therapeutics strategies that contribute to the management of the dysfunctions associated to Chronic Low Back Pain Syndrome.

Estudo comparativo dos mecanorreceptores dos discos intervertebrais normais e degenerados da coluna lombar de humanos pela radiografia, ressonância magnética e estudo anatomopatológico / Comparative study of normal and degenerated intervertebral discs' mechanoreceptors of human lumar spine X-ray, magnetic resonance and anatomopathologic study

Os autores fizeram um estudo da coluna lombar de humanos, objetivando avaliar e determinar os diferentes tipos de fibras nervosas no disco intervertebral normal e no degenerado. Foram usadas dez colunas lombares de cadáveres com aproximadamente 48 a 72 horas de óbito. As peças foram submetidas a exames de radiografia simples e ressonância magnética. Após os exames, os discos foram classificados em normais e degenerados. Em seguida, foram dissecados, divididos em regiões anterior e posterior, incluídos em parafina e realizado estudo de imuno-histoquímica com a proteína S100. Com o auxílio de um programa de computador Image-Pro Plus (media cybernetics®), as fibras nervosas tiveram seu diâmetro medidos em micrômetros e classificadas em quatro tipos de fibras. Foram encontrados quatro tipos de fibras nervosas nas diferentes regiões discais. O número e o tipo de fibras variaram de acordo com a região e grau de degeneração do disco intervertebral. Concluíram que as fibras do tipo III são mais freqüentes na região anterior; as fibras dos tipos II e IV são mais freqüentes na região posterior, e as fibras do tipo I não apresentaram diferenças entre a região anterior e a posterior; além disso, o disco degenerado tem mais fibras nervosas que o disco normal.

The authors conducted a study on human lumbar spine, aiming to assess and determine the different kinds of nervous fibers in normal and degenerated intervertebral discs. Ten cadavers lumbar spines with approximately 48 - 72 of death have been used. The pieces were submitted to simple X-ray and magnetic resonance tests. Subsequently to the tests, discs were divided into normal and degenerated. Then, they were dissected, divided into anterior and posterior according to the region, included in paraffin and an immunohistochemical study with S100 protein was performed. With the aid of Image-Pro Plus computer software (media cybernetics) ®, nervous fibers diameters were measured as micrometers and classified into four kinds of fibers. Four types of nervous fibers were found on different disc regions. The number and kind of fibers varied according to the region and degree of intervertebral disc degeneration. It was concluded that type-III fibers are more common at the anterior region; type-II and type-IV fibers are more common at the posterior region, and type-I fibers do not show any differences regarding anterior and posterior regions; in addition, a degenerated disc has a higher number of nervous fibers than a normal one.