Intervenções da fisioterapia na instabilidade e dor cervical: um estudo de revisão

Abstract

INTRODUCTION: The stability of the cervical complex has been appointed as primordial to the functional optimization and to the articular protection, thus avoiding the symptoms and local and global pathological progressions. An imbalance in the functional length, in muscle recruitment and in the somatosensorial system can generate mechanical stress on various structures and overload contractile and inert tissues, directly or indirectly involved. Physiotherapy interventions found in the literature results from the application of manual therapies; feedback mechanism; exercises with varying frequency, length and load; exercises of muscle control in functional activities, and, continued education post-intervention. However, there is a controversy regarding the best techniques and its results. This how, the objective of the study was to verify the effectiveness of physiotherapy treatments in the gain of stability of the cervical spine, through a literature review. DEVELOPMENT: The findings in the literature showed physiotherapy techniques, recently introduced, compared when applied in an isolated form and in a combined form. This way, it was discussed techniques of muscle flexibility gain linked to the cervical and thoracic spine; relaxation techniques; manual therapy; postural control of the cervical spine, thoracic and lumbar (proprioception and kinesthesis); activation practice of the craniocervicais flexors muscle (isometric exercises and low load); exercises of strength-resistance and co-contraction of the neck muscles; functional training; education and counseling of the patient. CONCLUSION: The education and the engagement of the patient on the therapeutic process guaranteed an active participation and an activity distribution. In the kinesthesis training, the proprioceptive and positional perception of all the spine, pelvic girdle and scapular girdle presented good indications. Exercises and mobilizations to gain thoracic length, exercises of scapular and cervical retraction, flexion of the higher cervical, specific muscles stretching, usually were associated to the treatment and presented positive results. Furthermore, the muscle training should include activation exercises and control of the deep cervical muscles, progressing to the functional tasks of the higher members and to exercises that simulate the return of desired activities. Similarly, home exercises were instrumental for the evolution of the treatment and maintenance of obtained gains.