Efeitos do treino inercial do volante nos fatores de risco para a tendinopatia: revisão sistemática
DOI:
https://doi.org/10.47197/retos.v66.113782Palavras-chave:
terapia por exercício, modalidades de fisioterapia, medicina desportiva, tendinopatiaResumo
Introdução: As tendinopatias são altamente prevalentes, principalmente entre atletas. Este estudo analisa a evidência científica sobre os efeitos do treino volante nos fatores de risco da tendinopatia.
Métodos: Foi realizada uma revisão sistemática seguindo as guidelines PRISMA, com pesquisas na CINAHL, Medline, PubMed, Scopus e Web of Science. Foram incluídos ensaios clínicos randomizados e estudos clínicos que avaliam o exercício resistido com volante para a tendinopatia. Foram excluídos os estudos que não avaliaram alterações funcionais, morfológicas ou fisiológicas do tendão. Três revisores extraíram e avaliaram de forma independente a qualidade dos dados.
Resultados: Cinco estudos preencheram os critérios de inclusão, com atletas adultos em risco ou com diagnóstico de tendonopatia rotuliana, bem como atletas saudáveis. Os protocolos de treino duraram entre seis e 24 semanas. A maioria dos estudos reportou melhorias significativas na força e potência, bem como alterações estruturais como o aumento da área transversal do tendão e a redução da sua temperatura.
Conclusões: O treino flywheel melhora a força, a potência e a adaptação dos tendões em indivíduos fisicamente ativos. No entanto, são necessários estudos em larga escala e com um seguimento mais longo para confirmar a sua eficácia em populações maiores e na prevenção de tendinopatias.
Referências
Ackermann, P. W., & Renström, P. (2012). Tendinopathy in sport. Sports Health, 4(3), 193–201.
Ardern, C. L., Büttner, F., Andrade, R., Weir, A., Ashe, M. C., Holden, S., Impellizzeri, F. M., Delahunt, E., Dijkstra, H. P., Mathieson, S., Rathleff, M. S., Reurink, G., Sherrington, C., Stamatakis, E., Vicenzino, B., Whittaker, J. L., Wright, A. A., Clarke, M., Moher, D., … Winters, M. (2022). Implementing the 27 PRISMA 2020 statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: The PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. British Journal of Sports Medicine, 56(4), 175–195. https://doi.org/10.1136/bjsports-2021-103987.
Belavý, D. L., Ohshima, H., Rittweger, J., & Felsenberg, D. (2017). High-intensity flywheel exercise and recovery of atrophy after 90 days bed-rest. BMJ Open Sport & Exercise Medicine, 3(1), e000196. https://doi.org/10.1136/bmjsem-2016-000196.
Berg, H. E., & Tesch, A. (1994). A gravity-independent ergometer to be used for resistance training in space. Aviation, Space, and Environmental Medicine, 65(8), 752–756.
Bittencourt, N. F., Vaz, R., Garcia, L., Zwerver, J., & Mendonça, L. D. (2024). Incidence of lower limb ten-dinopathy: A 3-year prospective study of a youth elite athletes in a Brazilian sport club. Journal of Bodywork and Movement Therapies, 40, 461–464. https://doi.org/10.1016/j.jbmt.2024.04.042.
Brar, K. K., Bhardwaj, P., & Prabu, R. G. (2021). The influence of lower limb plyometric and resistance training on the stiffness of Achilles and patellar tendons in recreational athletes. Biomedical Human Kinetics, 13(1), 56-62. https://doi.org/10.2478/bhk-2021-0008.
Challoumas, D., Pedret, C., Biddle, M., Ng, N. Y. B., Kirwan, P., Cooper, B., Nicholas, P., Wilson, S., Clifford, C., & Millar, N. L. (2021). Management of patellar tendinopathy: A systematic review and net-work meta-analysis of randomised studies. BMJ Open Sport & Exercise Medicine, 7(4), e001110. https://doi.org/10.1136/bmjsem-2021-001110.
Chimenti, R. L., Neville, C., Houck, J., Cuddeford, T., Carreira, D., & Martin, R. L. (2024). Achilles pain, stiffness, and muscle power deficits: midportion achilles tendinopathy revision–2024: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 54(12), CPG1–CPG32. https://doi.org/10.2519/jospt.2024.0302.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised con-trolled trials. The Lancet, 376(9754), 1751–1767.
de Jonge, S., Van den Berg, C., de Vos, R.-J., Van Der Heide, H., Weir, A., Verhaar, J., Bierma-Zeinstra, S., & Tol, J. (2011). Incidence of midportion achilles tendinopathy in the general population. British Journal of Sports Medicine, 45(13), 1026–1028.
de Lacerda, A. P. D., de Andrade, P. R., Kamonseki, D. H., Parizotto, N. A., da Silva, A. S. A., de Medeiros, L. B., & de Almeida Ferreira, J. J. (2022). Accuracy of infrared thermography in detecting tendi-nopathy: A systematic review with meta-analysis. Physical Therapy in Sport, 58, 117–125. https://doi.org/10.1016/j.ptsp.2022.10.005.
de Oliveira, C. E. P., Moreira, O. C., Carrión-Yagual, Z. M., Medina-Pérez, C., & de Paz, J. A. (2018). Effects of classic progressive resistance training versus eccentric-enhanced resistance training in peo-ple with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 99(5), 819–825. https://doi.org/10.1016/j.apmr.2017.10.021.
Fernandez-Gonzalo, R., Lundberg, T. R., Alvarez-Alvarez, L., & de Paz, J. A. (2014). Muscle damage re-sponses and adaptations to eccentric-overload resistance exercise in men and women. Europe-an Journal of Applied Physiology, 114(5), 1075–1084.
Fulford, J., Eston, R., Rowlands, A., & Davies, R. (2015). Assessment of magnetic resonance techniques to measure muscle damage 24 h after eccentric exercise. Scandinavian Journal of Medicine & Sci-ence in Sports, 25(1), e28–e39. https://doi.org/10.1111/sms.12234.
Grävare Silbernagel, K., Thomeé, R., Thomeé, P., & Karlsson, J. (2001). Eccentric overload training for patients with chronic achilles tendon pain–a randomised controlled study with reliability test-ing of the evaluation methods. Scandinavian Journal of Medicine & Science in Sports, 11(4), 197–206.
Gual, G., Fort-Vanmeerhaeghe, A., Romero-Rodríguez, D., & Tesch, P. A. (2016). Effects of in-season in-ertial resistance training with eccentric overload in a sports population at risk for patellar ten-dinopathy. Journal of Strength and Conditioning Research, 30(7), 1834–1842.
Habets, B., & Van Cingel, R. (2015). Eccentric exercise training in chronic mid‐portion achilles tendi-nopathy: A systematic review on different protocols. Scandinavian Journal of Medicine & Sci-ence in Sports, 25(1), 3–15.
Heinemeier, K., Olesen, J., Haddad, F., Langberg, H., Kjaer, M., Baldwin, K., & Schjerling, P. (2007). Ex-pression of collagen and related growth factors in rat tendon and skeletal muscle in response to specific contraction types. The Journal of Physiology, 582(3), 1303–1316.
Helland, C., Bojsen-Møller, J., Raastad, T., Seynnes, O. R., Moltubakk, M. M., Jakobsen, V., Visnes, H., & Bahr, R. (2013). Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy. British Journal of Sports Medicine, 47(13), 862–868.
Hildebrandt, C., Zeilberger, K., Ring, E. F. J., & Raschner, C. (2012). The application of medical infrared thermography in sports medicine. INTECH Open Access Publisher.
Khan, M. H., Li, Z., & Wang, J. H.-C. (2005). Repeated exposure of tendon to prostaglandin-E2 leads to localized tendon degeneration. Clinical Journal of Sport Medicine, 15(1), 27–33.
Kingma, J. J., de Knikker, R., Wittink, H., & Takken, T. (2007). Eccentric overload training in patients with chronic Achilles tendinopathy: A systematic review. British Journal of Sports Medicine, 41(6), e3–e3.
Kongsgaard, M., Aagaard, P., Roikjaer, S., Olsen, D., Jensen, M., Langberg, H., & Magnusson, S. (2006). De-cline eccentric squats increases patellar tendon loading compared to standard eccentric squats. Clinical Biomechanics, 21(7), 748–754.
Kongsgaard, M., Kovanen, V., Aagaard, P., Doessing, S., Hansen, P., Laursen, A., Kaldau, N., Kjaer, M., & Magnusson, S. (2009). Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scandinavian Journal of Medicine & Science in Sports, 19(6), 790–802.
Kowalchuk, K., & Butcher, S. (2019). Eccentric overload flywheel training in older adults. Journal of Functional Morphology and Kinesiology, 4(3), 61. https://doi.org/10.3390/jfmk4030061.
Law, M., Stewart, D., Letts, L., Pollock, N., Bosch, J., & Westmorland, M. (1998). Guidelines for critical review of qualitative studies. McMaster University Occupational Therapy Evidence-Based Prac-tice Research Group, 1.
Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M. (2007). Critical review form–qualitative studies (version 2.0). McMaster University.
Manal, K., Roberts, D. P., & Buchanan, T. S. (2006). Optimal pennation angle of the primary ankle plantar and dorsiflexors: Variations with sex, contraction intensity, and limb. Journal of Applied Biome-chanics, 22(4), 255–263.
Mangine, R. E., Siqueland, K. A., & Noyes, F. R. (1987). The use of thermography for the diagnosis and management of patellar tendinitis. Journal of Orthopaedic & Sports Physical Therapy, 9(4), 132–140.
Maroto-Izquierdo, S., García-López, D., Fernandez-Gonzalo, R., Moreira, O. C., González-Gallego, J., & de Paz, J. A. (2017). Skeletal muscle functional and structural adaptations after eccentric overload flywheel resistance training: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 20(10), 943–951. https://doi.org/10.1016/j.jsams.2017.03.004.
McAuliffe, S., Tabuena, A., McCreesh, K., O’Keeffe, M., Hurley, J., Comyns, T., Purtill, H., O’Neill, S., & O’Sullivan, K. (2019). Altered strength profile in achilles tendinopathy: A systematic review and meta-analysis. Journal of Athletic Training, 54(8), 889–900. https://doi.org/10.4085/1062-6050-43-18.
Mondini Trissino da Lodi, C., Landini, M. P., Asunis, E., & Filardo, G. (2022). Women have tendons… and tendinopathy: Gender bias is a “Gender Void” in sports medicine with a lack of women data on patellar tendinopathy—A systematic review. Sports Medicine-Open, 8(1), 1–8. https://doi.org/10.1186/s40798-022-00455-6.
Morrissey, D. (2015). Guidelines and pathways for clinical practice in tendinopathy: Their role and de-velopment. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 819–822.
Murtaugh, B., & M. Ihm, J. (2013). Eccentric training for the treatment of tendinopathies. Current Sports Medicine Reports, 12(3), 175–182. https://doi.org/10.1249/JSR.0b013e3182933761
Nawoczenski, D. A., Barske, H., Tome, J., Dawson, L. K., Zlotnicki, J. P., & DiGiovanni, B. F. (2015). Isolat-ed gastrocnemius recession for achilles tendinopathy: Strength and functional outcomes. JBJS, 97(2), 99–105.
Neitzel, J. A., & Davies, G. J. (2000). The benefits and controversy of the parallel squat in strength train-ing and rehabilitation. Strength & Conditioning Journal, 22(3), 30.
Núñez, F. J., Galiano, C., Muñoz-López, A., & Floria, P. (2020). Is possible an eccentric overload in a rota-ry inertia device? Comparison of force profile in a cylinder-shaped and a cone-shaped axis de-vices. Journal of Sports Sciences, 38(14), 1624–1628. https://doi.org/10.1080/02640414.2020.1754111.
Padhiar, N., Al-Sayeagh, H., Chan, O., King, J., & Maffulli, N. (2008). Pennation angle of the soleus in pa-tients with unilateral Achilles tendinopathy. Disability and Rehabilitation, 30(20–22), 1640–1645.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetz-laff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pearson, S. J., & Onambele, G. N. (2005). Acute changes in knee‐extensors torque, fiber pennation, and tendon characteristics. Chronobiology International, 22(6), 1013–1027.
Peters, J. A., Zwerver, J., Diercks, R. L., Elferink-Gemser, M. T., & van den Akker-Scheek, I. (2016). Pre-ventive interventions for tendinopathy: A systematic review. Journal of Science and Medicine in Sport, 19(3), 205–211.
Petré, H., Wernstål, F., & Mattsson, C. M. (2018). Effects of flywheel training on strength-related varia-bles: A meta-analysis. Sports Medicine - Open, 4(1), 55. https://doi.org/10.1186/s40798-018-0169-5
Ramírez-delaCruz, M., Bravo-Sánchez, A., Esteban-García, P., Jiménez, F., & Abián-Vicén, J. (2022). Ef-fects of plyometric training on lower body muscle architecture, tendon structure, stiffness and physical performance: A systematic review and meta-analysis. Sports Medicine-Open, 8(1), 40. https://doi.org/10.1186/s40798-022-00431-0.
Raya-González, J., Castillo, D., de Keijzer, K. L., & Beato, M. (2021). The effect of a weekly flywheel re-sistance training session on elite U-16 soccer players’ physical performance during the competi-tive season. A randomized controlled trial. Research in Sports Medicine (Print), 29(6), 571–585. https://doi.org/10.1080/15438627.2020.1870978
Raya-González, J., Prat-Luri, A., López-Valenciano, A., Sabido, R., & Hernández-Davó, J. L. (2021). Effects of flywheel resistance training on sport actions. A systematic review and meta-analysis. Journal of Human Kinetics, 77, 191–204. https://doi.org/10.2478/hukin-2021-0020
Rees, J. D., Maffulli, N., & Cook, J. (2009). Management of tendinopathy. The American Journal of Sports Medicine, 37(9), 1855–1867. https://doi.org/10.1177/0363546508324283
Rekabizaheh, M., Rezasoltani, A., Lahouti, B., & Namavarian, N. (2016). Pennation angle and fascicle length of human skeletal muscles to predict the strength of an individual muscle using real-time ultrasonography: A review of literature. Journal of Clinical Physiotherapy Research, 1(2), 42–48.
Riel, H., Lindstrøm, C. F., Rathleff, M. S., Jensen, M. B., & Olesen, J. L. (2019). Prevalence and incidence rate of lower-extremity tendinopathies in a Danish general practice: A registry-based study. BMC Musculoskeletal Disorders, 20(1), 1–6. https://doi.org/10.1186/s12891-019-2629-6.
Rio, E., Moseley, L., Purdam, C., Samiric, T., Kidgell, D., Pearce, A. J., Jaberzadeh, S., & Cook, J. (2014). The pain of tendinopathy: Physiological or pathophysiological? Sports Medicine, 44, 9–23.
Ruffino, D., Malliaras, P., Marchegiani, S., & Campana, V. (2021). Inertial flywheel vs heavy slow re-sistance training among athletes with patellar tendinopathy: A randomised trial. Physical Ther-apy in Sport, 52, 30–37. https://doi.org/10.1016/j.ptsp.2021.08.002.
Sanz-López, F., Berzosa, C., Hita-Contreras, F., & Martínez-Amat, A. (2017). Effects of eccentric overload training on patellar tendon and vastus lateralis in three days of consecutive running. The Knee, 24(3), 570–579. https://doi.org/10.1016/j.knee.2017.03.002.
Sanz-López, F., Berzosa Sánchez, C., Hita-Contreras, F., Cruz-Diaz, D., & Martínez-Amat, A. (2016). Ultra-sound changes in achilles tendon and gastrocnemius medialis muscle on squat eccentric over-load and running performance. Journal of Strength and Conditioning Research, 30(7), 2010–2018. https://doi.org/10.1519/JSC.0000000000001298.
Sanz-López, F., Martínez-Amat, A., Hita-Contreras, F., Valero-Campo, C., & Berzosa, C. (2016). Thermo-graphic assessment of eccentric overload training within three days of a running session. The Journal of Strength & Conditioning Research, 30(2), 504–511. https://doi.org/10.1519/JSC.0000000000001071.
Sarmiento, S., Rodríguez-Matoso, D., Henríquez del Pino, Y., Álvarez-Piñera, L., García-Manso, J., & Ro-dríguez-Ruiz, D. (2014). Effects of flywheel resistance training for gait improvement in female Alzheimer’s patients. J. Strength Cond. Res, 28(48), 2019.
Selfe, J., Hardaker, N., Thewlis, D., & Karki, A. (2006). An accurate and reliable method of thermal data analysis in thermal imaging of the anterior knee for use in cryotherapy research. Archives of Physical Medicine and Rehabilitation, 87(12), 1630–1635.
Sharma, P., & Maffulli, N. (2005). Tendon injury and tendinopathy: Healing and repair. The Journal of Bone & Joint Surgery, 87(1), 187–202. https://doi.org/10.2106/JBJS.D.01850
Speed, C. (2001). Corticosteroid injections in tendon lesions. BMJ, 323(7309), 382–386.
Walker, S., Trezise, J., Haff, G. G., Newton, R. U., Häkkinen, K., & Blazevich, A. J. (2020). Increased fascicle length but not patellar tendon stiffness after accentuated eccentric-load strength training in al-ready-trained men. European Journal of Applied Physiology, 120, 2371–2382. https://doi.org/10.1007/s00421-020-04462-x.
Woodley, B. L., Newsham-West, R. J., & Baxter, G. D. (2007). Chronic tendinopathy: Effectiveness of eccentric exercise. British Journal of Sports Medicine, 41(4), 188–198. https://doi.org/10.1136/bjsm.2006.029769.
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